Business 
(To 
qualify, 
the 
business 
must 
be 
locally 
owned, 
independent 
and 
able 
to 
answer 
yes 
to 
all 
questions): 
Yes 
No 
the 
business 
is 
privately 
held 
Yes 
No 
the 
business 
is 
located 
in 
Scarborough, 
ME, 
Yes 
No 
the 
owner 
or 
majority 
of 
owners 
live 
within 
75mi 
of 
Scarborough, 
ME, 
Yes 
No 
the 
business 
is 
registered 
in 
Maine 
with 
corporate 
headquarters 
in 
Maine, 
Yes 
No 
the 
owner(s) 
must 
have 
full 
decision 
making 
authority 
over 
the 
business, 
including 
but 
necessarily 
limited 
to: 


-decisions 
regarding 
product(s) 
purchasing, 
pricing, 
& 
marketing, 
-decisions 
regarding 
wages, 
commissions, 
& 
bonuses 
(for 
self 
& 
employees), 
Yes 
No 
the 
business 
has 
no 
more 
than 
15 
outlets 
with 
the 
majority 
in 
Maine 


Nonprofit 
(To 
qualify, 
the 
nonprofit 
must 
be 
able 
to 
answer 
yes 
to 
all 
questions): 
Yes 
No 
the 
nonprofit 
is 
registered, 
operates 
in 
Scarborough 
Maine 
and 
has 
a 
valid 
501c3 
or 
fiscal 
sponsor, 
Yes 
No 
the 
board 
of 
directors 
has 
full 
decision 
making 
authority 


Individual 


Yes 
No 
I 
agree 
that 
I 
am 
making 
application 
for 
myself 
only 
and 
I 
do 
not 
represent 
any 
business 
or 
nonprofit 
organiza-
tion. 
I 
also 
understand 
that 
I 
am 
not 
entitled 
to 
the 
same 
benefits 
as 
business 
or 
nonprofit 
members. 


Contact 
Information 
(we 
do 
not 
share 
this 
information): 
Directory 
Listing: 
(membership 
includes 
listing) 


Name 
of 
Owner________________________________________ 
Name 
of 
Business/Organization 
Name 
of 
Contact 
_______________________________________ 
_______________________________________________________ 
Mailing 
Address 
_______________________________________ 
Website 


Phone 
Number 
________________________________________ 
Physical 
location(s) 
in 
Scarborough 
(if 
you 
have 
a 
store 
front 
that 
customers 
or 
clients 
visit, 
if 
not 
leave 
blank) 


Email 
________________________________________________ 



I 
am 
interested 
in 
(circle 
one 
or 
both) 
-volunteering 
and/or 
-serving 
on 
the 
board 
of 
directors 
This 
business 
is 
minority 
or 
woman 
owned 


AttachdescriptionfortheBuyLocalDirectory.Descriptionscanbenomorethan40wordsexcludingtheaboveinformation.Thankyou.
Please 
return 
this 
completed 
form 
with 
your 
check 
made 
payable 
to 
Buy 
Local 
Scarborough. 


I 
certify 
that 
the 
information 
above 
is 
correct 
& 
that 
I 
meet 
the 
eligibility 
criteria. 
Further, 
I 
understand 
it 
is 
my 
responsibility 
to 
alert 
Buy 
Local 
to 
changes 
in 
my 
contact 
and 
directory 
information, 
as 
well 
as 
changes 
to 
my 
eligibility 
as 
defined 
above. 
DATE________________ 
SIGNATURE_________________________________________________________________ 
MEMBERSHIP 
LEVEL 
_______$50 
(Business) 
_______$25 
(Nonprofit) 
_______$35 
(Individual) 
AMOUNT 
ENCLOSED 
$ 
________________ 


PO 
Box 
1193, 
Scarborough, 
ME 
04070 
buylocalscarborough@yahoo.com 
207.831.9568