Member Application

Welcome and thank you for applying to be a member/investor in Greater Fort Wayne Inc. All membership applications are subject to approval.

If you are an entrepreneur and would like to apply for the Greater Fort Wayne Inc. Bridge Program, click here.

For additional information or to discuss investor benefits or investor levels such as LFW Alumni, the Greater Fort Wayne Inc. Women's Network, entrepreneurs, and more, please contact Investor Services at 260 420-6945.

Business Information

Company Name: *

Leave Blank:

Phone: *

Website: *

Email:

Business Description (200 char max):

Directory Category: *

Employees: *

Full-time Part-time

Business Keywords (enter a space between words):

Comments / Questions:

ReferredBy:

Company's Fiscal Month : *

Physical Address

Line 1: *

Line 2:

City: *

State: *

Postal Code: *

Country: *

Mailing Address

Same as physical address

Line 1: *

Line 2:

City: *

State: *

Postal Code: *

Country: *

Social Networking:

LinkedIn Facebook Twitter

Primary Contact Information

First Name: *

Last Name: *

Phone: *

Cell Phone:

Fax:

Billing Contact Information

Same as Primary Contact

First Name: *

Last Name: *

Phone: *

Cell Phone:

Fax:

Membership Options

Membership Package: *

Investment Level 1: $400.00
1-10 Employees Investment Level 2: $600.00
11 -20 Employees Investment Level 3: $800.00
21-50 Employees Investment Level 4: $1,000.00
51-99 Employees

Additional Opportunities:

We will contact you with additional information.

KPC Business Weekly : $0.00
I do wish to receive the subscription to the Greater Fort Wayne Business Weekly, including the annual “ Book of Lists” (which has a value of $20.)

Payment Option:

Charge my credit or debit card

Print Application