Vendor Registration

Username*

Username*

Email*

Email*

First Name

First Name

Last Name

Last Name

Store Name*

Store Name*

https://minorityretail.com/store/[your_store]

Address 1*

Address 1*

Address 2

Address 2

Country*

Country*-Select a location-United States (US)

City/Town

City/Town

State/County

State/County

Postcode/Zip*

Postcode/Zip*

Store Phone*

Store Phone*

How do you identify as a minority-owned business?*

How do you identify as a minority-owned business?*Black / African American Owned Hispanic / Latino Owned Indigenous / Native American Owned Asian / Pacific Islander Owned Middle Eastern / North African Owned Multiracial Owned LGBTQIA+ Owned Women Owned Disability Owned Veteran Owned Refugee / Immigrant Owned Other

What is the name of your business?*

What is the name of your business?*

Is your business product-based or service-based?*

Is your business product-based or service-based?*Product Based Service Based

Do you own at least 51% of the business?*

Do you own at least 51% of the business?*Yes No

Password*

Password*

Confirm Password*

Confirm Password*

* Agree  Terms & Conditions