Adopt-A-Road Business Sponsorship Form

The United Counties of Stormont, Dundas and Glengarry collects personal information under the Freedom of Information and Protection of Privacy Act for the purpose of processing your application and general communication.

Choose a sponsorship option:

Litter Bug - $300.00

Your bi-annual financial contribution would assist in the seasonal maintenance of County Road, including roadside signage.

Caring Community - $1500.00

Your bi-annual financial contribution would be represented through large scale signage at a key County Road intersection (locations limited).

Sign Information

Name to appear on sign:

Environmental Message or Safe Community Message (to be approved by SDG):

Desired location of the sign:

Main Contact Information

Title:

First:

Last:

Name of company:

Address:

City/Town:

Province:

Postal Code:

Cell phone:

Office phone:

Email:

To complete your application, please make a cheque payable to United Counties of SDG – Adopt-A-Road Sponsorship, and mail or drop it off to our office at 26 Pitt Street, Cornwall, ON K6J 2P3.

If you require any assistance, please call our Transportation and Planning department at 613-932-1515, ext. 1218.

I solemnly declare that all the statements contained in this application and all the supporting documents are true.

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Adopt-A-Road Business Sponsorship Form

Sign Information

Main Contact Information