Civitas - Request a Proposal

FIRST NAME

LAST NAME

POSITION

EMAIL ADDRESS

OFFICE PHONE

ORGANIZATION

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

I Am Interested In Forming A District In (City Or County): *

I am interested in forming a district with the: *

THE DISTRICT WILL BE:

*

I am interested in a district that is a: *

How many properties/businesses will be in your district? *

HAVE YOU DISCUSSED THE PROPOSED DISTRICT WITH PROPERTY/BUSINESS OWNERS?

*

If yes, what has the reaction been?

Please provide background information on the area the proposed district will be in, including the reasons for establishing a district: *