ACCOUNT CREATION

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NAME - FIRST & LAST | Name of Woman who owns the Business.*
STORE NAME | Visible to customers*
EMAIL | All Communication pieces arrive here*
PASSWORD*
CONFIRM PASSWORD*

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COMPANY NAME*
BUSINESS OWNERSHIP*
BUSINESS TYPE*
NUMBER OF EMPLOYEES*
TOTAL EMPLOYEES?*
TEXT NOTIFICATIONS PHONE #*
DO YOU WANT TO IDENTIFY?*
INDUSTRY IDENTIFICATION*
CATEGORY*
WEBSITE URL, IF APPLICABLE:
EXTRA INFO ABOUT COMPANY?
WHY BE PART OF OUR MISSION?
REFERRED BY- NAME OR COMPANY
REFERRAL PROGRAM*
HOW DID YOU HEAR ABOUT US?
INSTAGRAM HANDLE? OR N/A
ARE YOU A MEMBER OF WBENC?
**WBENC# | REGION
ARE YOU SPONSORED?*
ACH PAYOUT: ACCOUNT NUMBER
ACH PAYOUT: ROUTING NUMBER
1: ADMINISTRATIVE (SKIP)
2: ADMINISTRATIVE (SKIP)
3: ADMINISTRATIVE (SKIP)
PLEASE ADD IN YOUR ORDER #*