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OpenNorfolk Request Form

2. Name of Restaurant *
4. Address of Restaurant*
6. Address Continued
8. City*
9. State*
10. Zip*
12. Name of Contact
14. First Name*
15. Last Name*
17. Phone Number*
18. Email Address*
22. Do you have a parking lot for your restaurant? *
    -- Select One --YesNo
23. Do you need to place outdoor dining on the sidewalk or in nearby on street parking? *
    -- Select One --YesNo
25. Do you have adequate lighting for outdoor dining in the evening? *
    -- Select One --YesNo
26. Do you have an ABC license? *
    -- Select One --YesNo
28. Do you have tables and chairs that can be used for outdoor dining? *
    -- Select One --YesNo
32. Do you need outdoor heaters? *
    -- Select One --YesNo
33. What kind?
    -- Select One --FreestandingHangingWall-Mounted
35. Do you have a 15 Amp circuit that can be dedicated to each heater, or room on your electrical panel to add dedicated circuits for heaters?
    -- Select One --YesNo
36. Please provide any additional comments or concerns you may have:
40. Are you a women-owned business?*
    -- Select One --YesNo
41. Are you a minority-owned business?*
    -- Select One --YesNo
Leave This Blank:


43. 1. Receive an email copy of this form.
44. Email address

    This field is not part of the form submission.

45. Submit

* indicates a required field