Brick & Mortar Data Form

Link Up Illinois Data Collection

Brick & Mortar
Name of Store*
Store Name*
Full ID*
Firm Type*

Food Co-opCorner Store/Convenience StoreNeighborhood Grocer/Small Grocery StoreMid-sized Grocery StoreFull-service SupermarketSpecialty StoreFood Delivery Service
Region

ChicagoChicago SuburbsNorthern ILCentral ILSouthern IL
Your name*
Your Email*
example@example.com
Enter the month for which you're entering data
Start Date for the 7-day range you're reporting for*

MonthDayYear
Start Date
End Date of 7-day range

MonthDayYear
Auto-populates
Error! Please change the end date to be 7 days after the start date!
Average Operating Hours Per Day*
Enter the average number of hours your store was open each day this week.

Link Up Illinois Data Collection