Contact Us Name(Required) First Last Email(Required) Phone(Required)Business Name(Required) Business EIN Number(Required) Business Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Description of Business(Required)How many employees does your business have?(Required)Is your business located in an urban, suburban, or rural community?(Required) Urban Suburban Rural Is your business located on a main street or downtown location in your community?(Required) Yes No Preferred Get Connected Vendor(Required) Coal Creative Design Done Right No Preference Who referred you to the Get Connected program?(Required) Do you have an existing website?(Required) Yes No Does product/pricing exist online?(Required) Yes No Does your business have all applicable licenses/registrations to sell products in Pennsylvania and other states?(Required) Yes No How long has your business been in existence?(Required)Is your small business considered a disadvantaged business enterprise?(Required) Women Owned Minority Owned Veteran Owned Disabled Veteran Owned None Is you business considered a family business or passed down from prior generations?(Required) Yes No Do you have website log ins?(Required) Yes No Do you have a domain and hosting provider?(Required) Yes No Is your domain registered?(Required) Yes No Who is your hosting provider? If you don't know, put "I don't know".(Required) Who is your domain provider? If you don't know, put "I don't know".(Required) Is your business using a third-party e-commerce platform? Example firms include Shopify, Etsy, Grubhub?(Required) Yes No What is your annual revenue for online sales?(Required)Do you currently use social media (Facebook, LinkedIn, Instagram, Twitter) to market your business?(Required) Yes No What Point of Sales (POS) system do you currently use? Are you using web analytics on your website?(Required) Yes No Please list your social media handles, if you have any.(Required)Please upload your logo file, if you have one.Accepted file types: jpg, jpeg, png, pdf, Max. file size: 64 MB.CAPTCHA
