ACCESS Marketplace Registration Form

ACCESS Business Marketplace

Program Application Form
Your privacy is our priority. Information shared through this form will be used exclusively to assess your eligibility for and participation in ACCESS Business Marketplace.

Please note that we can only accept applicants from Ontario.
To be eligible to apply for ACCESS Business Marketplace, you must first successfully complete the ACCESS Business Lab program.*

I certify that I have successfully completed the ACCESS Business Lab program.I have not completed the ACCESS Business Lab program.
In order to join ACCESS Business Marketplace, you must first complete the ACCESS Business Lab program. Click to register for ACCESS Business Lab.
Confirm your date of completion of the ACCESS Business Lab accelerator program.*

MonthDayYear
1. Personal & Contact Information
First and Last Name*
Email Address*
Primary Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Primary Phone Type*

HomeMobileOffice / WorkOther
2. Business Information

Please share details of your current operating business:
Business Name*
Business email address*
example@example.com
Primary Business Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Links to Website & Social Media (Facebook, Instagram, X, TikTok, Other)
(Optional) Please share company logo files, recent business plans, and other documentation from your operational business.

Cancelof
3. Media Consent and Release

As part of the program, we often publish feature stories and profile our clients and their businesses. We would like your consent to share such stories about you and your business.
If you complete the ACCESS Business Marketplace program, would you be interested in being featured in our Marketplace, Newsletter and Social Media platforms?*

YesNoNot sure: please contact me to discuss.
Do you authorize ACCESS Community Capital Fund to use your images or video footage, in whole or in part, individually or in conjunction with other images and video footage, to be displayed on its website and other official channels, and to be used for media purposes including promotional presentations and marketing campaigns? You agree to waive rights to privacy and compensation, which you may have in connection with such use of your name and likeness, including rights to written copy that may be created in connection with video production, editing and promotion therewith. **

I agreeI do not agree
Today's Date*

MonthDayYear
Date
Enter your signature here*
Should be Empty:

ACCESS Business Marketplace

1. Personal & Contact Information

2. Business Information

3. Media Consent and Release