To sign up as a participating trader please complete this registration form :

Please note that if you are outside of the Rochford District you will currently be ineligible for this project

* Required fields

Your business details
Company name*
Type of business*	(description up to 40 chars)
Contact details
First name*
Last name*
Address*
Address 2
Town*
County*
Postcode*
Website*
E-mail address*
Twitter
Telephone number*
Create your own Shop at my Local website login account
Website username*
Website password*
Other info
How did you find us?	Please select Hockley Chamber of Trade Rayleigh Chamber of Trade Rochford Chamber of Trade Essex FSB Hawkwell Parish Council Hockley Parish Council Hockley Parish Plan Group Hullbridge Parish Council Rayleigh Town Council Rochford District Council Google Live Search Yahoo Search Leaflet In a Local Shop Newspaper - Echo Newspaper - Echo Newspaper - Standard A Shop at my Local Event Recommendation Other
	If Other, please specify
Enter our anti-spam code *	(it is case-sensitive)
Digital Signature*	I hereby apply to join the Shop At My Local campaign and agree to the Trader Pledge. Yes, I agree

Alternatively, apply by post

You can download the registration form, print it out, complete, sign and post back to the address shown on the form.

Note : Please do not use staples as it will cause problems at the Post Office sorting office.

The next step ....

Once your application has been received you will receive an e-mail confirming your registration and you will receive your welcome pack in the post.

Thank you for supporting the campaign!