Indie Business Network ENTREPRENEUR MEMBER Application (US)

IMPORTANT: This IBN Membership Application Form is for US members only.
Canadian members, use this application.

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.
Co-owner

Use this field to add the name of the co-owner if the business is owned by more than one person.
How did you hear about Indie Business?
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*
MM slash DD slash YYYY
Promotion Consent*
One of the things we love to do is promote our members across social media, thus expanding your sphere of influence and giving more people access to your brand. To do this, we use product photos posted on your Instagram account, and we tag you.
- Yes, please! I would LOVE free promotion of my business!
- No, thank you. I'm not interested in potential buyers learning about my business.
Any special requests?*
Now that you are an Indie Business™ member, we want to know what we can do right now, in this moment, to make your day even more special. What's your special request? We'll get right on it!
Please click the "YES, I agree" to acknowledging consent to storing and using your personal information to become an Indie Business member and get in touch with you.*
Indie Business will send or share the data on this form with InfusionSoft.
- Yes, I agree
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