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2. Mosquito Fire Business Recovery Information

4. Placer County Economic Development is collecting business information for those affected by the Mosquito Fire.  Our office will be sharing information and resources via email as they become available. Please complete the form below to be added to our contact list.

6. First Name
7. Last Name
9. Email Address
11. Phone Number
12. Alt. Number
14. Business Name
16. Business Address
18. City
19. State
20. Zip Code
22. Mailing Address (if different from above)
24. City
25. State
26. Zip Code

28. I consent to receive emails from Placer County Economic Development on business recovery information.

30. Electronic Signature
Leave This Blank:


32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit

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