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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