City of Temple Terrace Customer Service

Shop Local, Dine Local, Support Local Community Program (Business Participation Form)

2. Business Participation Information
   Please use this form to submit or update your discount offerings.

   Please use this form to submit or update your discount offerings.

4. Business Legal Name*

5. Fictitious or DBA Name

   If different from Business Legal Name.

7. Street Number*

   Street number of your brick & mortar location.

8. Street Name*

   Street name of your brick & mortar location.

9. Street Type*

   Road, Avenue, Street, etc...

10. Unit, Suite, Apt. No.

12. City*

13. State*

14. Zip*

16. Business Contact Person - First Name*

17. Business Contact Person - Last Name*

19. Contact - Telephone (1)*

20. Contact - Telephone (2)

22. Contact - Email Address*

26. Discounts Offered under the program.
    Please choose one or more of the following discount options and enter the details you would like to offer.

    Please choose one or more of the following discount options and enter the details you would like to offer.

28. Percentage Discount

    Set a percentage discount for the entire purchase, excluding alcoholic beverages. Example: 10% OFF entire purchase.

29. Fixed Discount

    Set a fixed discount amount with certain conditions, excluding alcoholic beverages. Example: 5% OFF purchase of $50 or more.

31. In-Kind or Promotional Offering

    Provide a free in-kind offering with eligible purchase. Example: FREE DESSERT with purchase of two adult entrees.

32. Term Special

    Offer a set discount on a particular item or category for a set period. Rotate the offering each period (ex: each month). Example: 50% OFF appetizers in July.

34. Thank You!
    Your support and participation is greatly appreciated. Someone will be in touch soon.

    Your support and participation is greatly appreciated. Someone will be in touch soon.

Leave This Blank:


35. 1. Receive an email copy of this form.
36. Email address

    This field is not part of the form submission.

37. Submit

* indicates a required field