P. O. Box 400, Meadville, MS  39653 ~ 601.384.2280

   A new business will be chosen each month by the Business of the Month Selection
          Committee.  Please print and complete as much of the below form as possible and return either
          by mail or in person at our office on Main Street in Meadville next to the courthouse.

Business Being Nominated:  ___________________________________________________

Owner's Name:  _____________________________________________________________

Businesses Street Address:  __________________________________________________

City:  _________________________________________      State:   MS     Zip:   ________

Businesses Phone Number:  __________________

Your Name:  ________________________________________________________________

Your Phone Number:   __________________

Your Signature:   ____________________________________________________________

Your name and phone number will be kept confidential and is required
only in case the selection committee needs additional information.

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