Resident Name *

Head of Household or Person Completing Form

First Name

Last Name

Business Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

We commit to stem the bleed of local dollars by keeping as much of our household money (whether earned wages or government subsidies) in the community through: *

Check all that apply

Getting as many as groceries as possible from Northside markets and grocers

Purchasing personal and household items from stores located on the Northside

Owning or buying a house on the Northside

Renting my house from a landlord that lives locally

Accessing beauty or barber services from Northside vendors

Looking at local stores first for anything I need

We pledge to encourage local businesses to facilitate accessibility by: *

Check all that apply

Speaking up when we need ADA accomodations (https://www.ada.gov/resources/title-iii-primer/)

Requesting language access services when needed

Teaching business owners when needed about practices, beliefs, or needs so they can better meet them

Report abuses to the proper authorities

We are taking ownership of the Northside by: *

Check all that apply

Owning our home

Owning a business that operates in or out of the Northside (in whole or in part)

Owning other property on the Northside (vacant land, rental properties)

I do not own anything on the Northside

We pledge to prioritze local investment opportunities first when possible, including: *

Check all that apply

The starting of new businesses

Purchasing a home to live in or rent to others

Charitable Giving and Volunteer Service

Banking and Investing