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2. First Name*
3. Last Name*
5. Business Name*
7. Physical Address*
9. City*
10. State*
11. Zip Code*
13. Phone Number*
14. Business License Number*
16. Website
18. Facebook
19. Instagram
21. About Your Business*

    Please include a paragraph or facts about your business. Some items you may want to include:

    • History
    • How long you have been in business 
    • How and why you started the business
    • How are you unique or what are your specialties?
    • What are your most popular products/services?
    • What do you enjoy about being part of the Wellington community?
23. Business Photo or Logo
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25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit

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