CMBCC Membership Form

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Select a CMBCC Membership Level* This field is required.Membership includes: - Access to all CMBCC programs. - Invite to all CMBCC Membership meetings (all Membership meetings will incorporate Business & Professional development training). - Complimentary BBOC* Premier Membership: BBOC Membership places you directly in front of 27,000 consumers
$99 Small Business (Holiday Special )
$99 Non-profit ( Holiday Special )
$75 Professional (Holiday Special )
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Business Owner* This field is required.
First Name
Last Name
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Business Name* This field is required.
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When did you start your business? Example: 4/10/2018* This field is required.
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Contact Number* This field is required.
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Type of Business* This field is required.
Please Select
Please Select
General Business Categories:
Advertising & Media
(Publishers, Public Relations, Marketing)
Auto & Motorcycle
(Automobile Dealers, Auto Body & Painting, Auto Clubs, more...)
Business & Professional Services
(Business Coaching, Consulting, Business Services)
Computers & Telecommunications
(Computer/IT Services, Telecommunications)
Construction & Building Services
(General Contractors, Construction, Engineers, Architects)
Education
(Colleges & Universities, Educational Services, K-12 Schools)
Entertainment
(Arts, Entertainment, Recreation, Travel, Events, Museums)
Non-Profit Organizations
(Family, Community & Civic Organizations)
Finance & Insurance
(Banks, Financial Advisors, Insurance)
Government
(Government)
Health & Fitness
(Medical Centers & Clinics, Dentists)
Home & Garden
(Home & Garden, Remodeling - Bath & Kitchen)
Hospitality
(Hotels & Motels, Event & Meeting Facilities, Resorts)
Legal
(Legal Services, Divorce/Family Law)
Personal Services & Care
(Salons & Spas, Funeral Homes, Driver Training, more...)
Public Utilities & Environment
(Utilities, Internet, Cable)
Real Estate, Moving & Storage
(Residential, Commercial, Moving, Storage)
Restaurants
(Full Service, Casual Dining, Fast Food)
Shopping & Retail
(Appliances, Clothing Apparel, Accessories, more...)
Sports & Recreation
(Golf Courses & Country Clubs, Sports Facility, Sports Teams)
Transportation
(Automobile & Truck Rental, Airport Parking) Others, please specify below.
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Website * This field is required.
Please provide a Social Media url of you do not have a website. ( For Example: Https://www.Facebook.com/BBOC )
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E-mail* This field is required.
example@example.com
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Demographic Ownership* This field is required.
Black-Owned
Woman-Owned
Veteran-Owned
Disabled-Owned
N/A
Other
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What is your Business Structure: Sole Entrepreneur, LLC, Non-Profit, S-Corp, C-Corp, Partnership?
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Business Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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Business Location:
Physical Location: Own Property
Physical Location: Rent Property
Online Business: Home-based (Home owner)
Online Business: Home-based (Rent Home)
Online Business: Co-working Space
Other
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Who is your Target Audience? (Demographically: Age, Race etc), )
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Do You maintain a banking relationship with a bank and/or credit union? If So, please list the name of the banking institution(s) below.
This information is for data reporting purposes only. Your business will not be directly associated with said listed banking institutions, nor will this questionnaire impact your current banking relationship(s).
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Do you sell Product(s), Service(s), or both? Please Describe in detail Below.
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Are you a certified vendor with the City of Charlotte, Mecklenburg County, or the Stare of NC? If so, which demographic category are you registered? Feel free to List any other Certifications like ByBlack.us.
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What percentage of the company is owned by you? 100%, 50%, 25%, Less than 25%, etc
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What is your Gross Annual Revenue?
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What is Your Website & Social Media Handle(s)? Sample Format: Https://www.CMBCC.org Https://Facebook.com/YOURBUSINESS
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What are your Greatest Challenges as a Business Owner?
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In the past 6 months have you experienced a business-related emergency or hardship that has drastically impacted your business? If So, Please discuss in detail. (For Example: My business experienced a break-in (or fire etc) and our insurance did not cover 40% of damages. This has resulted in my business being open less days, a loss of $21,000 when compared to ytd profits…. An increase in customer complaints, etc)
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Invoicing Notice & Data Release Notice: Invoices must be settled within 24hrs, to avoid cancellation or loss of discount(s). You are giving CMBCC permission to use the information provided in this membership registration form, to better assist black-business owners. Please confirm you have read and fully understand the Payment Notice & Data Release Notice by Typing Your Full Name Below * This field is required.
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