Nominate

Please take your time when filling out this nomination form. Changes will not be allowed once you have submitted your nomination.

Main Street Name*

Is there a formal organization working to improve this ‘Main Street’?*

If yes, please give us the formal name of the organization

Organization Contact Name (Please include if you know who the primary contact is)

Address

City*

State*

Zip Code

Phone Number* (numbers only, no hyphens, dots, or spaces)

Email (Please include if they have one)

Organization Website
(Please include http://)

Help your Main Street stand out to voters by adding a photo or logo:
(Recommended size: 460 x 368 pixels; JPG format; 1000k limit)

File size exceeds 1000K limit. Please choose another image.

First Name*

Last Name*

Email*

Nominator is:

I have read and agree to the Official Rules of this sweepstakes.*
I am 18 years of age or older.*
I would like to receive consumer oriented 'buy local' tips, tools and other information to help me support locally owned businesses.
I would like to receive the monthly Independent We Stand business e-newsletter which contains articles, tips, resources and more that can help small businesses discover and celebrate their local roots.

   

[Main Street Name]

[CITY], [STATE]

[Stating the reasons why this business should be nominated greatly increases the chance of winning.]