Black Owned Business Registration Form

Register Your Business

Please provide all required details to register your business with us.
Full Name *
E-mail *
example: yourname@email.com
Phone Number

Area Code Phone Number
Business Name *
Business IG *
Please do not add the "@"
Website
Type of Business *
Service-Based Businesses *
Other
If we have not listed your business category, use this space to add it here.
Check all that apply

Handmade Eco-friendly/Sustainable LGBTQIA+ owned Plus-size options available
Business Address
Select all that apply about your business location

Brick & Mortar Virtual/Mobile I also rent out my space for events.
If you'd like to refer other Black-owned businesses, add their info here.
Separate by comas
Message/Note
Totally optional.
By checking this box, you certify that the business in this form is a Black-owned business. By definition, this means at least 51% of the ownership of this company is owned by a Black person. *
Should be Empty:

Register Your Business