BizLINC Registration Form

What type of Membership are you interested in?*

Name*

First NameMiddle NameLast Name

Birth Date

MonthDayYear

Gender

Ethnicity

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

E-mail

example@example.com

Mobile Number

Phone Number

Work Number

How did you hear about BizLINC?*

Other

Company Name*

Business Structure*

If you chose partnership as your business structure, what percent of the company do you own?

Do you have a business bank account?

Upload Sunbiz Registration (If Applicable)

Upload your most recent Sunbiz Annual Report (If Applicable)

What is your role in the company? ie, owner, employee etc.*

What is your area of expertise?*

In what stage is your business?

Stage 1: Start Up ($0-$50,000 Annual Revenue)Stage 2: Growth & Expansion ($51,000-$150,000 Annual Revenue)Stage 3: Soar ($151,000 and up Annual Revenue)

Give us a brief bio about you and your company*

What would you consider the greatest need for your business?*

The BizLINC community is a place of collaboration, creativity, and connection. It's designed to be a place where dreams can be realized and hustles are legitimized.

I understand that BizLINC does not and can not guarantee that I will be successful in my business, but BizLINC will do its best to connect the community to the necessary resources to remove the barriers.

Your success will be a result of your time, energy, and coachability is not based on the completion of the programs, workshops, and offerings.

I further understand and authorize BizLINC to provide applicable information to the assigned mentors, partners, and facilitators.

I understand that we have the right to accept or deny applications for any reason. No person will be excluded from participation in or otherwise subjected to discrimination in regard to services, programs, and employment provided by BizLINC based on race, sex, color, national origin, sexual orientation, disability, age, or religion.

Assigned Mentor Connection

Agree to Terms and Conditions*

LINC Up!

Upload Your Business Tax Return (If Applicable)