Online Form - Local Directory Form

Business Name (If Applicable)

First Name*

Last Name*

Residential / Business Address

Street Address:*

City:*

State:*

Post Code:*

Country:

Telephone Number

Fax Number

Mobile Number

Website

Operating Hours

Please write a 50 word max description of your business for our website*

Unless otherwise stated, this information will be used for the purpose of the Shire of Victoria Plains Telephone Directory and Website Directory only. You can include as much or as little info as you would like.

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