This Form is for Non-Profit Organizations Only
CLICK HERE for the Chepachet.com Business Application Form

 Instructions

1. Complete the form below, filling in any information that applies to your organization AND that you want published on the internet. Most info is optional.
2. Click on the "Submit" button at the bottom of this page to send your application to Chepachet.com.

Your Name REQUIRED
Your Email REQUIRED
Organization Name
Slogan or Motto
Contact Person
Street Address
Mailing Address
Town
State
Zip
Contact Phone
Contact E-Mail
Web Site Address
Hours
Directions to Location
Handicapped Facilities	Check all that apply:  Ramps  Parking  Restrooms  Other (list below)
Description/Profile Describe your company or organization briefly, using a maximum of 200 words. We have a Web Site Search Feature, so be sure to include key words that your customers might be looking for (Ex: thrift shop, babysitting, fundraising ideas, etc). Writer's block? See one of our listings for ideas or jot down a few phrases and we'll compose it for you!
Logo or Photo You are allowed one logo, photo, etc. for your Chepachet.com page. You may send the image electronically as a .jpg or .gif file, or you may mail good quality art work to be scanned by us.  I will e-mail the logo/photo  I will mail the logo/photo  Please return my logo/photo
I hereby authorize publication of the information contained herein on Chepachet.com.