Business Member Application Business Name* Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Business Phone*Business Email* Hours of Operation*Website Social Media (ie- Facebook, Instagram, Twitter)Contact Name* First Last Contact Phone*Contact Email* Do you need a new exterior photo? Yes No If yes, will you provide? Yes No Do you need new interior photo(s)? Yes No If yes, will you provide? Yes No Do you need your business information/description updated? Yes No Description of business/services offered:*If yes, please provide the new description or bullet points for copy development.Would you like to be featured in the Visit New Harmony Map? Yes No
