Join Directory - Northland BIPOC Buisness Directory

First and Last Name:

Pronouns

Name of Business (This will be shown on the website)

Does your business have a physical location?

Yes
No
Mobile - ie Food Truck

Business Address (This will be shown on the website)

City, State, Zip

Business Phone Number (This will be shown on the website)

Business Website (This will be shown on the website)

Business Email (This will be shown on the website)

Business Description ( a few sentences or less...This will be shown on the website)

Business Social Media Accounts

Please provide Full URLS

Select a category that best fits your business (Select all that apply)

Restaurant/Food Service
Product (Retail / Shopping, etc)
Services (Salon, Legal, Consulting, etc)
Arts and Entertainment
Not for profit
Other (please specify below)

What other category best fits your business?

What industry does your business below to (Select all that apply)?

Please specify which industry

Please describe: What business organizations/groups are you a member?

What race/ethnicity do you identify? (Select all that apply)

Black/African-Heritage
American Indian / Alaska Native
Latino / Latinx
Native Hawaiian
Asian, Pacific Islander, Desi American
Another Way

Please Specify

Which gender do you most identify? (Select all that apply & Optional)

Male
Female
Transgender
Nonbinary
Two Spirit
Intersex
Another way:

Please specify (optional)

What are your business needs?

Financing
Physical Location
Technical Assistance
Other

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