Basic Business Listing Form

Please fill out the information below

Name: *

Business Category: *

What category is or would your business be listed under in the phone book. 1 category listing for BASIC Membership.

Business Name:

If you use your personal name for your business name, you can leave blank.

Business Description:

Please describe your business / establishment.

Street Address 1: *

Street Address 2:

City: *

State / Province: *

Postal Zip Code: *

Public Address?: *

Do you want your address to be shown to the public?

Contact Name:

If this business is anything other than a sole proprietorship, who do you want as a "contact" person?

Contact Phone Number:

For NAOTW's records, what is the phone number you would like to be contacted through?

Contact Email Address:

For NAOTW's records, what is the email address you would like to be contacted through? Forms will keep email addresses hidden.

Web Site URL Address:

If you have a web site, please fill in the address. NOTE: This requires a reciprocal link returning to NAOTW home page.

Native?: *

Are you Native American or does your organizations / business benefit Native people?

Tribal Affiliation:

Please list your tribal affiliation.

Tribal Membership:

If you are a member of a tribe, list the tribe here.

CAPTCHA

This question is for testing whether you are a human visitor and to prevent automated spam submissions.

Math Question: * 1 + 8 =

Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.

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