City of Keller Business Questionnaire

Page 1 of 1

1.	Business Name*

2.	Owner Name

3.	Street or physical address*

4.	Mailing Address, if different from physical address

5.	Name of Shopping Center

6.	Business phone number*

7.	Business fax number*

8.	E-mail Address*

9.	Business Web site *

10.	Is your business a member of the Greater Keller Chamber of Commerce?*
	YesNo

11.	Is your business a member of the Old Town Keller Merchants Association?*
	YesNo

12.

Emergency contact information

Contact 1 name
Contact 1 phone number
Contact 2 name
Contact 2 phone number

13.	Please include a brief description of your business that you would like to be included on the Keep It In Keller Web site*

City of Keller • Keller Town Hall, 1100 Bear Creek Parkway

P: 817-743-4000 • F: 817-743-4190 • E: townhall@cityofkeller.com