Form Center

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

Shop Small to Win Contest Entry-2021

  1. Shop Small to Win Slider
  2. Shop Small to Win

    Shop (online or in-person) from a Mount Airy independently-owned business!

    Shop November 1st through December 5, 2021 and spend at least $25.

    Submit your receipt by December 7th at 4:30 PM for your chance to win the Grand Prize worth $5,000!

    Grand Prize includes $4,500 in cash plus $500 in gift cards to Mount Airy businesses.

    You may enter as many times as you wish!

  3. One receipt is one submission and may not be duplicated. If you have two receipts from the same store that total at least $25, please email with an image of the second receipt.
  4. Receipt must total at least $25.
  5. Only purchases made 11/1/2021 - 12/5/2021 are eligible

  6. If it weren't for this contest, would you have made this purchase at a Mount Airy store?*
  7. Please include as much contact information as possible. If we are unable to contact the chosen winner, another winner will be selected on December 13, 2021.
  9. Entries must be received by Tuesday, December 7, 2021 at 4:30 PM.

    Receipts may also be dropped at Mount Airy Town Hall's drop box by December 7, 2021 at 4:30 PM. The address is:

    Town of Mount Airy

    110 S. Main St

    Mt. Airy, MD 21771

  10. Winner will be contacted using the contact information provided starting December 10, 2021 immediately following drawing.

    Check presentation will be the week of December 12, 2021.
  11. A printable entry form can be found at Information for Businesses Page. Printed forms will be available outside Town Hall.
  12. Leave This Blank:

  13. This field is not part of the form submission.