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2. Village of Lombard Electronic Sign Request Form
4. Village of Lombard 255 E. Wilson Avenue Lombard, IL 60148 Phone: 630-620-5700 Fax: 630-620-8222 www.villageoflombard.org
6. Today's Date (NO EARLIER THAN 8 WEEKS AND NO LATER THAN 4 WEEKS PRIOR TO EVENT.) *
   Today's Date (NO EARLIER THAN 8 WEEKS AND NO LATER THAN 4 WEEKS PRIOR TO EVENT.)

   Today's Date (NO EARLIER THAN 8 WEEKS AND NO LATER THAN 4 WEEKS PRIOR TO EVENT.)
8. 1. Community Event
10. Display is limited to 2 weeks. What two weeks would you like to run your message?
12. Start Date*
    Start Date

    Start Date
13. End Date*
    End Date

    End Date
15. Email Address*
17. Name of Organization*
19. Contact Person*
20. Daytime Phone #*
22. 4 LINE LIMIT- EACH LINE HAS 18 CHARACTER LIMIT.
32. For Office Use Only
Leave This Blank:


36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit

* indicates a required field