test form - The Village Trip

These details will appear on the Village Trip website

Name of business*

As you would like it to appear on the website

Brief description of your business*

We will use this to create your profile on The Village Trip website

Seating Capacity*

Cuisine Category*

Select one below

Special Offer: Prix Fixe Offering for $19.69*

Select all that apply

Special Offer: Special Price*

Select all that apply

Describe $5 breakfast offer

Which days?*

Select all that apply

Street address

As you would like it to appear on the website

Business phone number

Website

Your logo

Please upload your logo as you would like it to appear

Optional photograph

Please upload a photograph to appear alongside your business profile (optional)

Contact name

Contact phone number

Contact email address*

Mailing address

(if different from street address)

Street Address Address Line 2 City State ZIP Code