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GROW Nebraska™
 
Retail Membership

Please note all information will remain confidential and will be held at the GROW Nebraska™ office. I agree that if GROW Nebraska™ services assist me and my business becomes successful I will continue to provide mentoring or financial support for the program.

Basic membership through December 31, 2008 is $150 and includes the following:

  • A page on the GROW Nebraska™ web site; one photo, contact information and a brief description of product(s) or service
  • E-mail updates regarding events, workshops and other training opportunities
  • Technical assistance
  • Discounts from other GROW Nebraska™ members
  • Press release writing service for special events
  • If joining before March 1, a listing in the 2008 GROW Book; if after September 1, a listing in the 2009 GROW Book.
All information provided to GROW Nebraska™ is kept in strictest confidence. Much of the funding that allows GROW to develop new programs comes from grants. Please provide the following information so we can provide full statistics to our grantors, with guaranteed anonymity for our members, on the businesses we serve and the growth that they achieve.

I understand that my membership is good through December 31, 2008, unless I am joining between September 1 and December 31, 2008, when membership will be good through the end of 2009.

Membership Form 2008 - Retail
*Date:
Business Information
*Name of Business:
*Date Business Started:
*Primary Contact Person:
*Form of Business:
Sole Proprietorship
Partnership
Corporation
Cooperative
*Address:
*City:
*State:  
*ZIP:
*County:
*Phone:
( )   -
Fax:
( )   -
Email:
Web Site:
Year Web Site Launched:
Gross Sales for 2007:
$0-25,000
$25-50,000
$50-100,000
$100-150,000
$150,000+
*How did you find out about us?
Referral
GROW Web Site
Radio
Newspaper
REAP
Other:
If referred, who referred you?
*Type of Retail Business:
Antiques/Galleries
Apparel/Gifts
Art Gallery
Book Store
Card & Gift
Catalog/Mail Order
Convenience
Gift
Department
Drug
Florist
Furniture/Gifts
Garden/Nursery
Gift Basket
Hair Salon
Hospital
Lodging
Interior Design
Jewelry
Non-Profit Gift
Office Supplies
Restaurant
Smoke Shop
Supermarket Florist
Tea Room/Coffee Shop
Variety
Other:
Discount to Members
If you would like to offer a year-round
discount on your product or service to
other GROW members, please list it here.
Owner Information
*Owner Name:
*Is your contact information the same as
given in the business information?:
Yes
No
Address:
City:
ZIP:
State:  
Phone:
( )   -
Fax:
( )   -
Email:
*Gender:  
*Date of Birth (MM-DD-YYYY):
*Ethnic Origin:  
Co-Owner Information
Co-Owner Name:
Is your contact information the same as
given in the business information?:
Yes
No
Address:
City:
State:  
ZIP:
Phone:
( )   -
Fax:
( )   -
Email:
Gender:  
Date of Birth (MM-DD-YYYY):
Ethnic Origin:  
REAP Membership
*I have not previously been a member of the
Rural Enterprise Assistance Project (REAP),
live in a rural county and wish to try their
business-building services for the first year
at no additional charge.
Yes
No
*Do you have a Nebraska
Tax ID Number (you must have
a NE Tax ID to be a member
of GROW Nebraska)? :
Yes
No
Basic membership for 2008 is $150. You may choose the services you participate in, OR take advantage of new bundle pricing and participate in all services - including any new ones developed in 2008 - without additional administration fees.* Current fee-added services include: Archway Gallery, Kearney Year-Round Store, Product Evaluation, Web Site Critique, State Fair Store, Holiday Stores, and full text in GROW Book. You will be prompted for payment information following submission of this form. You may pay with Visa, MasterCard, American Express, Discover, PayPal or by check.
*Commission rates still apply for retail opportunities.
*Will you be paying online
or would you like to be invoiced?
Online
Invoice
*Please indicate what services
you would like to pay for.
Basic Membership ($150)
Archway ($25)
Kearney Store ($25)
Bundle Fee ($275)
By submitting this form, you verify the above information is valid and give permission to use your name/business name/photograph in publications, advertisements, news articles or Web sites pertaining to GROW Nebraska. You certify that you have a Nebraska sales tax id number. You agree that if GROW Nebraska services assist your business in becoming successful, you will provide mentoring or financial support for the program.


  
P.O. Box 7 • Holbrook, NE 68948 • Phone: 888.GROWNEB • Fax: 308-493-5396
©2008 GROW Nebraska™ • Pictures Provided By: Authors of Light