The Black Shopping Networks

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Business Name*

Name*

Email*

Phone*

Street Address*

State*

Zip Code*

How Did Your Hear About Us? (optional)

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*

I sell tangible products

I provide a service

Number of Products to be Offered*

Social Media URls

Business organization memberships (BBB, industry organization, etc) optional

Business Type*

Name of Owners*

Sales Average for the Past 3 Years

Number of Employees

Years in Business

EIN #

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