| Personal Information |
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First and Last Name:
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Title:
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Company Name:
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Address:
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City:
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State/Province:
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Zip/Postal Code:
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Country:
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Other:
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Phone:
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Fax:
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E-mail Address:
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Web Site URL:
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| Business Information |
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Type of Business:
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Number of Employees:
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Yearly Sales Volume:
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Number of Years in Business:
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| Government
Funding Information |
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Type
of Business:
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Products/Services:
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Is
this a new or existing business? (If existing, how long):
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Estimated
Cost of Venture:
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Have
you already had dealing with consultants/funding organizations
concerning your venture? If so, with whom?:
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Please
describe the nature of your proposed venture:
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Assistance
Required:
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Do
you have a business plan available for review?
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If
no, when will it be available?
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Do
you need any assistance in completing a business plan?
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