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Business Directory Information Form
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Town of Purcellville Business Directory Submission Form
We are excited about publishing an online directory of all businesses located in the Town of Purcellville. Please enter your information below. You can contact us at business@purcellvilleva.gov with any questions.
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If you do not wish to be included in the online business directory, please select the check box here.
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Business Contact Information
Enter the contact information for your business
Business Name
*
Enter the name of your business as you want it to appear.
First Name
Last Name
Address1
*
Address2
City
*
State
*
Zip
*
Business Phone
*
Enter Main Business Phone Number
Business Phone 2
If desired, enter a second Business Phone number.
Business Email Address
*
Email address for contacting business or proprietor.
Business Website
Website address for business.
Business Profile
Enter a brief profile of your business.
Business Type 1
*
-- Select One --
Retail/Shopping
Restaurant/Coffee/Tea
Professional Services
Independent Contractor
Non-Profit
Educational Entity
Religious Entity
Medical Services
Recreation
Automotive Services
Other
Choose your primary business type.
Business Type 2
-- Select One --
Retail/Shopping
Restaurant/Coffee/Tea
Professional Services
Medical Services
Educational Entity
Religious Entity
Automotive Services
Recreation
Non-Profit
Independent Contractor
If you wish, choose a secondary Business Type.
Description of Business
Provide a brief description of your business and services provided (max 255 characters).
Affirmation
*
I affirm the information contained herein is accurate.
Yes
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Email address
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