MyWellsvilleKS Multi-Purpose Contact Form

INSTRUCTIONS:
This is a multipurpose form and is for submitting information relating to the various directories and features available in the MyWellsvilleKS.com website.

- All submitters must complete the first section ("Contact Information").
- Then, find the section the that you wish to submit information for and complete that section.

This form is multi-purpose and can be used for the Following Submissions:

● Community Bulletin Board ● Business Directory ● Day Care Directory

● Organization & Services Directory ● Employment/Business Opportunities Listings

Also, If you are not submitting information for any of the directories/listings and just have questions or comments; please use the "Question/Comment" section that is available at the bottom of every web page on this site. Thank you.

Submitter/Contact Information

This section is to provide MyWellsvilleKS administration with contact information. The sections following this, relate to information that will be posted on the website.

* Name

* Contact Phone:

* Email Address

*I Am Submitting Information For:
note: More than 1 response is permitted

Community Bulletin Board-Item/Service/Event	Business Directory	Community Organization/Services
Day Care Directory	Employment/Business Opportunities

*asterisk denotes required response

Address (physical and/or mailing):

Questions/Comments .... intended for the MyWellsvilleKS admimistrator

Business or Community Organization Directory ......... includes sole proprietors (individuals) and Day Care Providers

Below is the requested information to be posted on the MyWellsvilleKS website. Each field is optional.

Business/Organization Name:

Primary Phone:

Alt. Phone:

Fax Number:

Contact Email:

Website Domain/URL Address:

Bus./Org. Address:

Hours of Operation:

Type of Org./Bus. or Service Provided:

Upload Organization Photo/Logo

Provide a brief description of your organization or business (75 word max.):

0/75 words

Additional Information/Questions/ Comments (for website administrator):

Community Bulletin Board

Ensure you have completed the contact information in the first section above.

Community Board Catagory

Catagory Header

Upload Photo or File (click on "?")

Provide the Text of Your Ad (limit of 50 words)
Include Your Contact Information.

0/50 words

Employment/Business Opportunity Listings

Description of Job or Business Opportunity, also list contact information:

0/100 words

Title of Job/Position:

For Employment:

Deadline to Apply:

Always open - no deadline

Open until filled

Must be submitted by:

* Indicates Response Required