Indie Business Network Membership Application

** US members: Complete and submit this form to become an Indie Business Network member!

Name*
First Last
Please share the name of the primary owner of the business. If the business is co-owed by two or more people, please include one name and contact us to update the directory with complete information once membership has been processed.
How did you hear about IBN?
Business Name*
Phone*
Cell Phone*
Email Address (will not be shared publicly)*
Enter Email Confirm Email
Address (will not be shared publicly)*
Street Address Address Line 2 City State Zip Code
Website URL (skip if you do not have one)

This makes it easier for us to promote your business.
Company Description*
Your Blog Address (skip if you do not have one)

This makes it easier for us to promote your business.
Your Facebook Business Page (skip if you do not have one)

This makes it easier for us to promote your business.
Your Pinterest Page (skip if you do not have one)

This makes it easier for us to promote your business.
Your Instagram Page (skip if you do not have one)

This makes it easier for us to promote your business.
Tell us your birthday*
Date Format: MM slash DD slash YYYY
Please click the "YES, I agree" to acknowledging consent to storing and using your personal information to become a member of the Indie Business Network and get in touch with you.*
- Yes, I agree
The Indie Business Network will send or share the data on this form with InfusionSoft.