Beautification Dedication Program

Application Form

(Please Print Clearly)

Applicant Information:

Name:	Phone:
Address:	Fax:
City, Province:	Postal Code:
Email:

Donation Information (Please indicate the donation type)
Bench	Tree	Pet Stand	Bike Rack/Post

Payment Options:
Cheque/Money Order (payable to the Town of Espanola)
Cash
Debit

Submit completed application and payment to the Town of Espanola, 100 Tudhope St, Ste 2, Espanola, ON P5E 1S6.

I have read, fully understand and agree to abide by the Beautification Dedication Program Policy and Guidelines.

My signature below indicates that I have read this document in its entirety and understand that:

The Town makes all final decisions, including but not limited to availability, item location and tree species.

All language used on the recognition plaques is subject to approval.

All items are the property of the Town of Espanola and will be maintained according to the Town’s policies and procedures.

Signature:	Date: