Forms • Collinsville, OK • CivicEngage

Business/Organization Name:*

Business Location:*

City:

Business Phone:

Business Email:

As a participant in the contest I will donate a small item to the "I LOVE Collinsville" gift basket to be given away in a drawing to a lucky voter in the contest. My donation will be ready to be picked up at my business no later than February 10:

I will donate:

Donation Value:
(No purchase necessary. No cost to enter. No need to be present to win.)

Please add my business to the City of Collinsville Mobile Phone App with the information provided below.

YES

NO

Business Category *

Brief description of your business:

Upload a photo or logo you would like to display if room allows.

Convert to PDF?
(DOC, DOCX, XLS, XLSX, TXT)

Please copy a link to your website or social media page you want viewers to be directed to when they click your listing.*

THE FOLLOWING INFORMATION WILL NOT BE PUBLISHED ON THE APP.

Owner/Contact for the business:

Owner/Contact Email:

Owner/Contact Phone:

Owner/Contact Mailing Street Address:

Owner/Contact City:

Owner/Contact State:

Owner/Contact Zip Code:

AGREEMENT:

By submitting this listing we understand and agree to have the stated business appear on the City of Collinsville mobile app. Users will have a direct link to the business from the app. We also agree to indemnify and hold harmless the City of Collinsville, it's employees, and agents against any and all claims resulting from our participation in having our business listed on the City of Collinsville mobile app.

PLEASE NOTE:
Beginning June 30, 2023 the mobile app business listing will only be published once the annual City of Collinsville business license has been renewed and license fee ($5.00) has been received.

Form submitted by:

Date:

* indicates required fields.

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