Indie Business Protégé Member Application

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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 TikTok 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
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.*
- Yes, I agree
Indie Business will send or share the data on this form with InfusionSoft.
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