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Please complete and submit the information below to help us better understand your capital need. We will contact you within five business days.

What is your role?
Name:
Company:
Telephone:
Email Address:

Please limit each answer below to one short paragraph.
Do not submit Executive Summary or Business Plan until requested.
What is your business? Describe. Date founded?
What are your historical sales and profits? 1998 1999 2000 2001  2002 (Est.)
Sales
EBITDA*
* Earnings before interest, taxes, depreciation, and amortization
Describe the purpose for which you need capital:
(Startup, expansion, purchase of another firm, working capital, debt repayment, building purchase, or other)
Have you tried to obtain capital in the past? From whom? Results?
How much capital are you seeking?
Describe the major markets you serve:
Who is your competition?
Describe your competitive advantage in this market:
What is your exit strategy?



This web site was updated on April 2, 2003
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