Christmas Decoration Program Application

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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)

    (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.

    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. Large Holiday Snowflake ꟷ 2-Year Investment

    1. $500 (includes Banner)

    Placed at intersections along Delmas Avenue*

40. Standard Holiday Snowflake ꟷ 2-Year Investment

    1. $350 (includes Banner)

    Placed along Delmas Avenue*

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45. *All Christmas Decorations are placed according to space availability by Main Street Pascagoula.

47. TEXT FOR BANNER

49. Please enter the text you would like to appear on your banner.*

51. PAYMENT INFORMATION

53. Payment Type*

    1. Check
    2. Credit Card

54. Instructions for Checks
    Make Checks Payable to "Main Street Pascagoula" and mail to 618 Delmas Avenue, Pascagoula, MS 39567

    Make Checks Payable to "Main Street Pascagoula" and mail to 618 Delmas Avenue, Pascagoula, MS 39567

56. Credit Card Number

57. Exp. Date

    MM/YY

58. CCV #

60. 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

62. SIGNATURE

64. 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.
66. Electronic Signature*

68. Confirmation will be sent once payment is processed.
    For more information, please email CommunityRelations@CityofPascagoula.com or call (228) 372-6877

    For more information, please email CommunityRelations@CityofPascagoula.com or call (228) 372-6877

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

    This field is not part of the form submission.

72. Submit Submit and Print

* indicates a required field