COVID-GRAY CRG ~ Community Resource Guide

Upon completion of this form we will email you your GRAY CRG PROOF for your review and approval within one business day.

*Asterisk denotes required field.

*Choose one, GRAY CRG base rates for BROWARD Co.:

($10 service charge retained if cancellation notice is given after the 9th of the month)

Examples: Chiropractic Physician, Colon Therapy

*(1) ITEM - Business or Professional Name

Three additional ITEMS are included with your basic listing. It's $5 every month for each additional ITEM over 4.

(2) ITEM - Contact Name
When including professional degrees earned, kindly limit to the top 2.

(3) ITEM - Additional Contact Name

(4) ITEM - Address
Enter a comma after the street address, then add the City, State, and zipcode.

(5) ITEM - Telephone
Please use dashes. Example: 954-630-1610

(6) ITEM - Fax

(7) ITEM - Email
Reminder: each ITEM you include over 4 is an additional cost.

(8) ITEM - Website (URL)

Your Business or Professional Name will be highlighted with 100% black ink. Tell us which additional ITEM (as entered above) you also choose to be highlighted.
Telephone NumberEmail AddressWeb Address

*Description (40% black ink)
Use this section to share benefits, products and services. The basic listing includes up to 30 words.

Would you like assistance in reducing your description to 30 words, as there is a monthly charge of $1/word over 30?
Yes please.No thanks.
We recommend you make a backup copy of your description prior to "submitting," in the event this form does not process correctly.

Image (optional)
Types of images acceptable: png, jpg, gif, and pdf. 2 MB file size limit. Remove any slashes and spaces within your graphic file name prior to uploading. For best printed results, set resolution at 150 dpi or higher.

Contact/Billing info (for internal use only)
*Your Name:
*Your Phone:
*Your Email:
Name on Card:
Street Address associated with card:
City, State, Zip:
For security purposes, we'll connect by telephone for your credit card information.

COMMENTS: Kindly let us know how we may be of additional assistance.