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COVID-19 Restaurant Info

2. Restaurant Name*
4. Address1
6. Address2
8. City
9. State
10. Zip
12. Phone Number
14. Food Service Options

    Check all that apply.

    1. Delivery
    2. Curbside options
    3. To-Go options
    4. Catering
16. Email
    We will only use this to contact you if we have additional questions.
Leave This Blank:


18. 1. Receive an email copy of this form.
19. Email address

    This field is not part of the form submission.

20. Submit

* indicates a required field