Vendor Pool Sign up Form
Thank you for your interest in being listed as a viable vendor with Business Empowered Mississippi. Please complete the information below and you will be notified when vendor opportunities are available.
Name of Company/Group/Organization/
Owner’s Full Name
First Name
Last Name
E-mail
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Website
Are you registered with the state you live in?
Yes
No
What type of vendor are you?
Give a brief description of your products and/or services.
Upload Photos of your products or merchandise.
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Upload your company logo.
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Preferred Vending Areas:
Central Mississippi
South Mississippi
North Mississippi
Other States
If you checked “Other States” List Your Preferred States.
Any special message you need us to know/
Submit Form
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