2. 
4. 
6. 
8. 
10. Application Date
    Application Date
12. APPLICANT INFORMATION
14. Business Name
    If Applicable
16. Last Name*
17. First Name*
18. MI
20. Street Address*
22. City*
23. State*
24. Zip Code*
26. Phone Number*
27. Email Address*
29. DECORATION TYPE AND BANNER INFORMATION
31. Please choose one Decoration Type by checking the box next to the fee
    (to purchase multiple Christmas Decorations, please complete a separate form for each)
33. Christmas Decoration purchases are a two-year commitment. Upon renewal, prices will be discounted.
    Pricing includes the production, installation, maintenance, and removal of the banner and lighted decoration.
35. MEMORIAL ANGELS
36. HOLIDAY SNOWFLAKES
38. Memorial Angel ꟷ 2-Year Investment

    1. $350 (includes Banner)

    Placed along Beach Boulevard*
39. Holiday Snowflake ꟷ 2-Year Investment

    1. $400 (includes Banner)

    Placed along Delmas Avenue*

41. 
42. 
44. *All Christmas Decorations are placed according to space availability by Main Street Pascagoula.
46. TEXT FOR BANNER
48. Please enter the text you would like to appear on your banner.*
50. PAYMENT INFORMATION
52. Payment Type*

    1. Check
    2. Credit Card
53. Instructions for Checks

    Make Checks Payable to "Main Street Pascagoula" and mail to PO Box 1203, Pascagoula, MS 39568

55. Credit Card Number
56. Exp. Date
    MM/YY
57. CCV #
59. I authorize "Main Street Pascagoula" to charge my credit card above for the agreed upon purchase. I certify that I am an authorized user of this credit card.

    1. Agreed
61. SIGNATURE
63. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
65. Electronic Signature*
67. Confirmation will be sent once payment is processed.
    For more information, please email CommunityRelations@CityofPascagoula.com or call (228) 372-6888
Leave This Blank:


69. 1. Receive an email copy of this form.
70. Email address

    This field is not part of the form submission.

71. Submit Submit and Print

* indicates a required field