Previous Reference Number: Do no enter unless you are updating a previous entry

Please choose one:
Business
Club or Organization

Submitted by:
First and Last Name:
Position in Business or Organization:

General Information:
Business or Organization:
Street Address:
City: , Missouri - Zip Code:

Product or Service:
Number of employees or members:

Normal Operating Hours/Meeting Times:
Meeting Place: (Optional)

Any Other Information: (Note: This section should give more information about your organization or business. (Feel free to include a mission statement, directions to your location, special times of services/events, anything the general public should k now-- no advertising please.)

Phone Numbers: (Optional)
VOICE: Area Code: Phone Number:
FAX: Area Code: Phone Number:

Please choose a Category Below: (Note-- more than one can be chosen.)

Agriculture Church Club / Organization
Educational Entertainment / Recreation Financial Services
Government Health / Family Services Manufacturing
Transportation / Communication Professional Services Restaurants / Lodging
Retail / Wholesale OTHER

Key Words:

Contact Information: (Optional)
Contact Person:
Contact's A/C & Phone Number: Extension:
Contact Person's e-mail address:
Internet Home Page Address:

OR

NOTE: Please submit your organization only once. If you receive a reference number after you "Send Form," then your submission was successful. Thanks.