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Have an amazing idea or product….tell us about it!

Company Name *

Description *

Contact Name *

Title *

Phone *

Email *

Email

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Website *

Product *

Years in Business *

Sales Range *

Region(s) of Interest *

Midwest
Soutwest
Rocky Mountains
East
Pacific Northwest
California

Do you have a current broker in region(s) of interest? *

Yes
No

If yes, who is/are your current broker(s) in this region? *

Are you raising capital? *

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What makes you uniquely situated to win against your competition? (250 max characters) *

Website

Please send samples to the below address in order for your line to be reviewed:

L.A. Libations
Attn: Business Development
715-B N Douglas Street
El Segundo CA 90245

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