Black-Owned Business Registration Form
Help us support our own!  Register your black-owned business or one you support below!
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Business Name or DBA *
First & Last Name of Business Owner(s) *
Email Address *
Phone Number *
Address *
Website *
Social Media Handles (3 max) *
Brief Description of Products or Services *
Is this business legally registered with the State of FL ( *
Is this business legally registered with another state? *
Is this business recognized by the federal government by an EIN or SSN (sole proprietor)? *
Do we have permission to publish the information collected in this form on our website, social media, and future publications? *
First & Last Name of Person Completing This Form (if NOT the business owner listed above)
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