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Name: *
Company: *
Address: *
City: *
State: *
Zip: *
Phone Number: *
E-mail: *
 
Proposed site: street intersection *
City: *
State: *
Type of Site:
Size: *
Frontage: *
Depth: in feet
Total Square Footage: in feet *
If site is larger than 1/2 an acre, will the owner divide this Lot? *
Any existing Wienerschnitzel restaurants within 3 miles? *
 
Comments: