Memorial Highway Business Enrollment
Complete this form if you would like to enroll your business in the Memorial Highway Business Support Program
Business Name
Business Phone Number
Please enter a valid phone number.
Business Email
example@example.com
Business Website
WebsiteDomain.com
Business Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Point of Contact Name
First Name
Last Name
Point of Contact Phone Number
Please enter a valid phone number.
Point of Contact Email
example@example.com
Select Memorial Highway Assessment Level
Level 1
Level 2
Neither (Not eligible for program enrollment)
Are you a member of the Mandan Progress Organization?
Yes
No
No, but I would like to learn more
Does your POS support the ability to manually enter a credit card?
Yes
No
Does your POS support tap-to-pay?
Yes
No
Submit
Should be Empty: