Pre-Tenancy Application Form
REFERRAL BUSINESS NAME:
Virtual Property Desired:
*
Kiosk $100/mo
Store $150/mo
Food Court Space $125/mo
Premium Store $200/mo
Book Store $50/mo
Music Store $50/mo
Art Gallery $50/mo
Business Name:
*
Please List Your Business Website:
*
Your Business Social Media Page and Platform:
*
EX: @TheBlackVirtualMall INSTAGRAM
What Industry Is Your Business In?
*
Please Select
Accessories
Beauty
Books/Art/Music
Children's Products
Clothing & Shoes
Food & Beverage
Health
Home Products
Service Based
Food Court Applicants Must Use A Delivery Service. Please List All Delivery Services You Use:
UberEats
PostMates
Door Dash
GrubHub
Caviar
Other
Please provide the direct links to your page for each Delivery App:
Please add 5 - 10 Keywords to let people know what your business offers
*
Music Artist ONLY (Not producers selling beats). Provide the direct link to 1 song for preview:
If you have a Welcome Video that will appear when people visit your store please provide a YouTube or Vimeo link - if Youtube, be sure the video is NOT listed as "FOR" kids or it can't be shared. If you don't have a video now, don't worry, if you are approved you'll be able to provide a link after your Store/Kiosk is active in The Black Virtual Mall.
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Applicant Personal Information
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number. You will be notified via SMS of your application status.
Email
*
example@example.com
Applicant's Signature
Clear
Date Signed
-
Month
-
Day
Year
Date
Submit
Should be Empty: