ADam Website Registration

Please complete the following:

New registration:________

Renewal registration:________

Billing Information:   Name ______________________________________________________ 

                             Billing Address: ______________________________________________
                                                                City, State, Zip                     

Information For Website:  Business Name: __________________________________________  
(Businesses will be listed on the website based on the name registered on the business license.)               

                             Address: _________________________________________
                                                                      City, State, Zip                                   

                             Phone:  __________________  Fax: ___________________ 

                             Email Address:  __________________________________________ 

                             Web Site URL: __________________________________________ 

                             Type of business: __________________________________________ 

Fees
Business in town limits with a Damascus business license
$ 25.00
Business out of town limits. 50.00
One time set-up fee,
new listings only
$25.00
Reasonable requests for changes are free. There will be a fee for multiple requests.

Make Check Payable to Town Of Damascus-ADam and mail with this form to PO Box 576, Damascus, VA 24236
or Bring by the Treasurers Office at the Town Hall. Please mark Attention: ADam Committee.

Contact information for questions.

Town Of Damascus, PO Box 576, Damascus VA 24236, (276) 475 3831