Interested In Joining Our Black Business Directory

Contact Information
Name of Person Submitting This Interest Form*
First Last
Are you the business owner or referring a business?*
- Business Owner or Acting on Behalf of Business Owner
- Referring A Business
Relationship to Business (i.e. Business Owner, Employee, Customer, etc)
Email*
Business Information
Name of Business*
Owner Name*
First Last
Description of Business*
Contact Number*
Website

Example: https://www.fellowshipchicago.com
Does the business have a Social Media page(s)?
- Yes
- No
Facebook (Please include social media handle or link to page)
Instagram (Please include social media handle or link to page)
Twitter (Please include social media handle or link to page)
Other Social Media (Please include social media handle or link to page)
Discount Offered for Fellowship Members?

i.e. 10% off purchase, $10 off first purchase, free item with purchase, etc
Discount Expiration Date
MM slash DD slash YYYY
Discount Code
Please provide us with a Headshot of the Black Business Owner*
Max. file size: 256 MB.
Please provide us with the Business Logo*
Max. file size: 256 MB.
Please provide us quality images of your product(s)
Drop files here or

Max. file size: 256 MB.

Contact Information