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Green Massillon Road North Construction Communication Form

2. Business Name*

3. Type of Business
   -- Select One --Retail/RestaurantManufacturing/IndustrialOfficeMedical ServicesOther

5. Primary contact person*

7. Physical Street Address*

9. Mailing Address (if different from physical address)

11. City

12. State

13. Zip Code

15. Email*

17. Primary Contact Person Direct Phone Number*

19. Cellphone Number

21. Preferred method of communication*

    1. E-mail
    2. Text
    3. Phone Call -- Primary Contact Phone Numberr
    4. Phone Call -- Cellphone Number

23. Secondary contact person

    (Store manager, key employee, etc)

25. Email

27. Phone Number*

29. Cellphone Number

31. Preferred method of communication*

    1. E-mail
    2. Text
    3. Phone Call -- Secondary Contact Phone Number
    4. Phone Call -- Cellphone

33. Any additional info regarding preferred method of communication

35. Peak business hours?

    (Deliveries, employee arrival/departure times, etc.)

37. Hours of operation

39. Biggest concern/question regarding construction?

41. Addition comments

Leave This Blank:


42. 1. Receive an email copy of this form.
43. Email address

    This field is not part of the form submission.

44. Submit

* indicates a required field