Business/Consultant Referral

Address *

Website Address *
Business Phone *

- Area Code Phone Number
Main Contact's Direct Line *

- Area Code Phone Number
Main Contact's Email *
example@example.com
Will the Main Contact be responsible for providing this Service? *

Yes No
Name of Service Contact (if different from Main Contact)

First Name Last Name
Service Contact's Direct Line

- Area Code Phone Number
Service Contact's Email
example@example.com
Members interested in your services will complete a form indicating their interest. These forms will be sent directly to the Main Contact's email and the Service Contact's email, if applicable. Would you like to have the form sent to a third email address, i.e., services@xyz.com?

No, the emails already included are sufficient. Yes, please send a third email identified below.
Third Email Address for Service Requests from our Members
example@example.com
Brief Description of Business *

0/360
Detail of Services offered to INN Members *

0/900
Rate and Discount for INN Members *

0/600
Bio of Business and/or Consultant (if not already included above)

0/360
Other

Please provide any additional information you would like to convey. 0/360
Should be Empty:

Business/Consultant Referral - Setup Form