The Black Shopping Networks

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Business Name*

Name*

Email*

Phone*

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Business by Industry*

Logo ( logo 250k or larger jpg or png)

Photo* (of your business, products or staff) photo (500k or larger jpg or png)

Website Url

Business Summary* (in 25 words or less)

Service or Product*

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Number of Products to be Offered*

Social Media URls

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Sales Average for the Past 3 Years

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Years in Business

EIN #

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