Beautification Dedication Program Application Form

Applicant Information

Name: *

Address: *

City: *

Province: *

Postal Code: *

Email:

Primary Phone: *

Fax:

Donation Type: *

BenchTreePet StandBike Rack/Post

Payment Options: *

Cheque/Money Order (payable to the Town of Espanola)CashDebit

Signature

I have read, fully understand and agree to abide by the Beautification Dedication Program Policy and Guidelines.

My signature below indicates that I have read this document in its entirety and understand that:

The Town makes all final decisions, including but not limited to availability, item location and tree species.
All language used on the recognition plaques is subject to approval.
All items are the property of the Town of Espanola and will be maintained according to the Town’s policies and procedures.

Signature: *

Typing a full name will be used in place of a signature

Date: *

Contact Email(s):

Enter contact emails to receive a copy of your submission (comma separated).

Captcha *