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#SiloamCares Business Opt-In Form

  1. Include the name of the participating #SiloamCares business
  2. This will be used on the City website for promotion.
  3. If you do not have an email where you receive business information, please submit N/A
  4. My business will comply with applicable directives issued by the Arkansas Department of Health related to COVID-19 and any executive orders issued by Governor Hutchinson.
  5. I will require our customers to wear masks and practice social distancing.
  6. My business provides hours for vulnerable populations, or provides curbside, delivery or quick pick-up.
  7. My business agrees to follow any new health care directives or updated/new executive orders.
  8. If my business does not comply with the above, it may be removed from the campaign list and no longer be promoted through the #SiloamCares campaign
  9. Leave This Blank:

  10. This field is not part of the form submission.