Interested In Joining Our Black Business Directory

Name of Business*
Owner Name*
First Last
Description of Business*
Business Phone Number
Website

Example: https://www.fellowshipchicago.com
Discount Offered for Fellowship Members?
i.e. 10% off purchase, $10 off first purchase, free item with purchase, etc
Discount Expiration Date
Date Format: MM slash DD slash YYYY
Discount Code
Please provide us with a Headshot of the Black Business Owner*
Please provide us with the Business Logo*
Please provide us quality images of your product(s)
Drop files here or
Contact Information
Name of Person Submitting This Interest Form*
First Last
Relationship to Business (i.e. Business Owner, Employee, Customer, etc)
Email*

Contact Information