Vermont Attorney General's Pure Vermont Award Nomination Form

Attorney General William H. Sorrell's Pure Vermont Award program was developed to recognize those individuals, businesses, and organizations that exemplify the best Vermont traditions. The award is given in recognition of efforts to protect consumers, promote awareness of consumer issues, promote fair dealing, and support a healthy consumer marketplace. 

Please complete the form below with information about the person, business or organization you are nominating, your information and contact information for any additional references, and your reasons for making the nomination. You may email any additional documentation to consumer@uvm.edu (please include "Pure VT" in the subject line), FAX to 802-656-1423 or mail it to the following address.

Mailing Address:

Pure Vermont Award
Consumer Assistance Program
146 University Place, Burlington, VT 05405

	*field required (if unknown, enter "NA")
Whom are you nominating?
Individual's Full Name (first and last):*
Name of Business (if applicable)
Mailing Address:*
City:*
State:*
ZIP:*
Daytime Phone:*
E-mail Address:
Information about you:
Your Name (first and last):*
Your Daytime Phone:*
Your E-mail Address
Your Relationship to Nominee:* (You are the Nominee's....)	Employer Co-worker Customer Community Member Service Provider Friend Family Member
	Other:
Reason for Nomination:* Why are you nominating this individual, business or organization for the Pure Vermont Award? Please provide a brief description, including any relevant dates or other pertinent information.
References: Are there others who can also speak to why this nominee deserves the Pure Vermont Award? Please provide names and daytime phone numbersor e-mail addresses for any references.
Thank you for nominating!

Last modified February 06 2013 01:24 PM