Non Third-Party Validated Businesses Application

Name of Organization

Brand Name (if different from organization name)

Year of Inception

Address

Postal Code

Name of Primary Contact

Primary Contact’s email

Primary Contact Phone Number

Organization website (include http://)

Business Categories - Add new category below if desired

Equity-Deserving Group

Company Description

Community & Social Impact

By submitting this form, I confirm that the information submitted for this application is accurate and that I must submit the required documentation and my business ownership documentation to Brent Brodie bbrodie@yorku.ca in order for my application to be assessed.