* 1.
Your Name (as listed in connection with your business)
* 2.
Name of Your Business
* 3.
Are you the sole owner of your business?
4.
If you are not the sole owner of your business, please name your co-owner(s) (as listed in connection with your business)?
* 5.
Is your business registered in the State of Missouri?
* 6.
Is your business registered in the State of Illinois?
* 7.
What area(s) does your business serve?
* 8.
How is your business certified? Please check all that apply.
* 9.
Is specific licensing required for your business/field of work?
* 10.
Are specific certifications required for your business/field of work?
* 11.
What type of business do you have? Please check all that apply.
* 12.
What type(s) of services and/or products does your business provide?
13.
Please include your contact information.
* 14.
May we include your business's information on the Shalom Church (City of Peace) website?