2019 Floyd County Map
Please note that this application is for one Display Ad (single or double size) to be included on the 2019 Floyd County Map. If you have an additional business to advertise, please submit an application for each display ad.
This form needs to be submitted online by clicking the submit button at the bottom. The form is set up to be transmitted to the designer along with admin contact, please do not print out questions and hand-write responses to submit.

CLICK ON "YOUR ANSWER" TO ENTER TEXT FOR THE QUESTION OR THE RADIO BUTTON IF SELECTING A CHOICE. ALL FIELDS REQUIRED. After answering all questions, once you click the submit button, the first email address at top of form will automatically receive a copy of the form responses by email.
Email address *
Business Name (for Billing) *
Your answer
Contact Name (for any chamber followup needed) *
Your answer
Contact Phone number (for any chamber followup needed) *
Your answer
Contact email address (first email address requested above is only for sending confirmation and copy of submission, done automatically by Google Forms. Email here is only for any chamber followup needed including sending the invoice.) *
Your answer
Billing Address (invoice will be sent by email with online payment option)
Your answer
Physical location for mapping location (street address, city, zip ) *
Your answer
Two-color Display Ad Options (based on standard business card size) are Single Ad - 2" H x 3.5"W; Horizontal Double Ad - 2"H x 7"W; or Vertical Double Ad - 4"H x 3.5"W *
I would like to utilize the payment plan (pay in two installments.) Final payment must be received by artwork submission deadline - Friday, September 6th. *
A copy of your responses will be emailed to the address you provided.
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