NEW CONCEPT SUBMISSION FORM

Anjar Co. LLC & Becker Asssociates LLC
42 Russet Road
Stamford, CT  06903
203-322-7396
PBecker@BeckerAssoc.com
www.BeckerAssoc.com

 NEW CONCEPT SUBMISSION FORM

 

 ___________________________________________________________Name ___________________________________________________________ Company ___________________________________________________________ Address ___________________________________________________________ City, State Zip ___________________________________________________________ Email

Home Phone _________________ Work Phone __________________  

Cell Phone  ___________________

___________________________________________________________Name of your New Concept 

Briefly describe your New Concept  ___________________________________________________________

___________________________________________________________

___________________________________________________________

___________________________________________________________

Use the space below to fully document and describe your submission. You may draw a representation of your New Concept. Do not refer to website for description, as websites change. Use a separate sheet of paper for additional space. Copy and use one form for each item you submit.

 

 
 _____ I agree that this Submission has not been solicited by Becker Associates LLC and that it is made voluntarily. Becker Associates is not expected to assume any further obligations with respect to your submission other than to say whether Becker Associates LLC may be interested in acquiring rights in your new concept for licensing or distribution. I acknowledge that I have the right to offer this Submission for the purposes stated herein.
Please be sure to enclose a check payable to: 

Becker Associates LLC, 42 Russet Road, Stamford, CT 06903.

_____ Enclosed is my $195.00 check, if you are in the U.S.

_____ Enclosed is my $245.00 check, if you are outside the U.S.

_____ I have attached additional documentation to this Submission Form.

_____ I have enclosed a model with this Submission Form. Do not submit model until Becker Associates requests it. 

___________________________________________________________Signature ___________________________________________________________Date

 

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