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Business Name(Required)

Business Address(Required)

Street Address Address Line 2 City State ZIP Code

Business Phone(Required)

Retail Location(Required)

No retail location

Retail location is same as Business Address (above)

Retail location is a different address than above

Address of retail location (if different than above)(Required)

Street Address Address Line 2 City State ZIP Code

Contact Person Name(Required)

First Last

Contact Phone(Required)

Contact Email(Required)

Business Type

Artisan

Bed & Breakfast/Lodging

Beer, Wine and Spirits

Farm

Farm Stands and U-Pick

Farm Tours

Farmers' Markets & Country Stores

Meat, Fish, Dairy, and Eggs

Nursery

Restaurant

Specialty Products

Community

OTHER/Not listed

Ararat

Axton

Bassett

Blairs

Boones Mill

Callaway

Cascade

Chatham

Claudville

Collinsville

Critz

Danville

Dry Fork

Ferrum

Fieldale

Glade Hill

Gretna

Hardy

Henry

Hurt

Keeling

Martinsville

Meadows of Dan

Patrick Springs

Penhook

Ridgeway

Ringgold

Rocky Mount

Stuart

Union Hall

Vesta

Wirtz

Woolwine

Community

Type of products or services

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