Request edit access
JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Business Information Updates for JCCDA
Jewell County Businesses
*This information is used for our information only to contact you if needed and for reports we do*
* Indicates required question
Business Name
*
Your answer
Business Owner(s)
*
Your answer
Contact Person
*
Your answer
Email
*
Your answer
Mailing Address (Street, City, State, Zip)
*
Your answer
Street Address (if different)
Your answer
Business Phone Number
*
Your answer
Cell Phone Number
Your answer
Business Website (or type NA if it doesn't apply)
*
Your answer
Services Offered/Type of Business
*
Your answer
Number of Full-Time Employees
*
Your answer
Do you have a business Facebook page/group?
*
Yes
No
Required
Comments
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Jewell County.
Does this form look suspicious?
Report
Forms
Help and feedback
Contact form owner
Help Forms improve
Report