Use this form if you are registering a business as a representative.

REGISTER VENDOR

Rep Assigned: *

Select Your Name

Chinelo O.
Constance A.
Josep N.
Karlene J.
Taysha R.
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PERSONAL DETAILS

First Name *

Last Name *

Mobile Phone *

BUSINESS DETAILS

Business Name *

Business Phone Number *

Business Email *

Business Address *

City *

Province/State *

Postal/Zip Code *

Country *

Country

Website

Does the Vendor agree to receive communication via email and SMS. *

YES

ALMOST DONE, ADD EXTRA VALUE!

1. Are you interested in us DRIVING MORE CUSTOMERS to your business? *

YES

NO

A Marketing Rep will be in touch.

2. Are you interested in small business loans, Government Grants, or a 50% Payroll subsidy? *

YES

NO

A Funding Representative will be in touch.

3. Are you interested in EXPOSURE at BUSINESS EXPOS? *

YES

NO

We will notify you of upcoming events.

4. As a BLAC Network Vendor, you may qualify for deep discounts on your insurance products. *

Yes, give me discounts.

No, I don't want discounts.

A licensed Agent will review for savings

5. Are you Interested in help setting up your store? *

YES, Help me do it

NO, I'll do it myself

Further instructions will be sent via email.

LAST STEP

READ THIS TO THE VENDOR
After I submit your request you will receive an email that requires you to accept our Terms of Service before we can get you started. May you do this now?

NOTE: GO TO NEXT
1. Use the vendors 10 digit phone# as the password on the Next Page.
2. Remember to ask the Vendor for the Business Service Types.

Press SUBMIT - You're All Done!

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