Food

All fields preceded by an * (asterisk) are required and must be filled in before continuing to the next part of the form.

Part 1: Business Name and Public Street Address (information released to public)
*Business Name:		Service type?	Fine Dining Fast Food Family Casual Restaurant/Bar Bar/Pub/Tavern Other, Specify: Do not display for this listing
*Street Address:
Suite:
*City:
State:	OR
*Zip:
Cuisine:	American Chinese French German Indian Italian	Japanese Lebanese Mediterranean Mexican Pizza Seafood	Steak Thai Other, Specify: Do not display for this listing

Part 2: Business Profile (information released to public)

Facility Description

*Hours of Operation:
(one paragraph max.; 250 characters max.)

*ADA Accessible?

Yes
No

Amenities:

Banquets
Catering
Live Music
Acting/Comedy
RV_Friendly

Fees: (one paragraph max.; 250 characters max.)

Payment Options:

Cash
VISA
MasterCard
Discover
American Express
Check

*Facility description:
(one paragraph max.; 400 characters max.)

Facility image:
(.jpg or .gif only; cannot exceed 150 pixel width)

Public Contact Info

*Phone:

Email:

Toll-Free:

Website:

Fax:

Directions from nearest route (highway)

*Route:

Milepost:

Longitude:

Latitude:

*Text directions from route:

(one paragraph)

Link to Map URL:

Part 3: OTIC Business Contact (not released to public)
Primary Contact Info
*First Name:		*Last Name:
*Phone:		Email:
Fax:		Email:
Alternate Contact Info (optional)
First Name:		Last Name:
Phone:		Email:
Fax:		Email:
Owning Business and Mailing Address
Check box if owning business name and mailing address are the same as the public business name and street address. Otherwise, uncheck the box and make changes as necessary below.
*Owning Business Name:
*Address 1:		Address 2:
*City:		*State:
*City:		*Zip: