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2. 
4. In an effort to support local restaurants during the COVID-19 Pandemic, the City of Tolleson is creating a dedicated web page with your restaurant information to the city website so our residents know when you are open and how you are conducting business. If you would like to participate please provide the following information:
6. Your First Name*
7. Your Last Name*
8. Business Name*
10. Business Address*
11. Business Phone *
12. Business Email
14. Do you have a valid business license to operate within the city of Tolleson?*

    1. Yes
    2. No
15. Type of food or restaurant*
16. Which service do you currently offer? (Check all that apply)*

    1. Pick-Up
    2. Delivery
    3. Take Out
    4. Temporary Closed
18. Days and Hours of Operation*
19. Business Web Address
21. Facebook
22. Instagram
23. Other social media accounts
25. Free 4x4 Banner
    
26. Request your free banner
    Free 4'x4' banners can be picked up or delivered by contacting:
    Email: FieldOps@tolleson.az.gov
    Phone: 623-936-7141
Leave This Blank:


28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit

* indicates a required field