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Buy Local Directory - Request Form
Complete this form to be added to the Buy Local Directory website.
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Email
*
Your email
Which county is this business located?
*
Coshocton
Holmes
Knox
Licking
Required
What is the Farm Bureau membership ID for you or your business/farm?
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I don't know my ID
*
Your answer
Business/Farm Name (exactly how it will be published)
*
Your answer
Business/Farm Contact Person Name
*
Your answer
Phone Number you want shared
Your answer
Business/Farm Street Address (if you want it shared)
Your answer
Business/Farm City
Your answer
Facebook Page
Your answer
Web Site
Your answer
Hours of Operation
Your answer
What product(s) or services are you providing?
*
Your answer
Are you providing a discount to Farm Bureau members? If so, please list exactly how it will be published.
Your answer
Send me a copy of my responses.
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