Rep. Fitzgerald's Small Business of the Month Nomination Form
Each month Representative Fitzgerald will be showcasing a small business in District 83 in his bi-weekly newsletter, on social media, and much more. If you know a small business that you believe should be recognized for their outstanding service to the community please fill out the form below.

If you have any questions or issues, please call 517-373-0835 or email JohnFitzgerald@house.mi.gov.
Sign in to Google to save your progress. Learn more
Email *
What is your name? *
What is your relationship to the small business? (owner, employee, patron, #1 fan, etc) *
Would you like to remain anonymous? *
Small Business Nominee
Below please provide information about the business you are nominating and why you believe it should be recognized as a Small Business of the Month
Nominee's Name *
Address *
Type of Business *
Why do you believe it should be recognized as small business of the month? (Provide a few sentences about their contribution to the community/neighborhood, etc.) *
Anything else we should know?
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms