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Black-Owned Business Registration Form
Help us support our own! Register your black-owned business or one you support below!
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* Indicates required question
Business Name or DBA
*
Your answer
First & Last Name of Business Owner(s)
*
Your answer
Email Address
*
Your answer
Phone Number
*
Your answer
Address
*
Your answer
Website
*
Your answer
Social Media Handles (3 max)
*
Your answer
Brief Description of Products or Services
*
Your answer
Is this business legally registered with the State of FL (
sunbiz.org
)?
*
Yes
No
Unsure; I am not the business owner
Is this business legally registered with another state?
*
Yes
No
Unsure; I am not the business owner
Is this business recognized by the federal government by an EIN or SSN (sole proprietor)?
*
Yes
No
Unsure, I am not the business owner
Do we have permission to publish the information collected in this form on our website, social media, and future publications?
*
Yes
No
First & Last Name of Person Completing This Form (if NOT the business owner listed above)
Your answer
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