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2. Business Name*
4. Contact Name*
5. Email Address
7. Mailing Address*
9. City*
10. State*
11. Zip Code*
13. Phone Number*
14. Business Website
16. Physical Address*
18. City*
19. State*
20. Zip Code*
22. Do you consent to sharing your business' physical location on the Town of Colonial Beach's official website?*

    1. Yes
    2. No
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24. 1. Receive an email copy of this form.
25. Email address

    This field is not part of the form submission.

26. Submit

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