First Name

Last Name

Street Address:

City:	State/Province:
Country:	Post/Zip Code:

Contact Telephone Number:

Home Work
Contact E-Mail Address:

Send me email when new listings are added.
Yes No

Objectives

I'm interested in the following BIC listing(s)
(Check as many as you wish)
Beverage and Food Services
Water Laboratory and Treatment
Manufacturer
Full Service Plumbing Contractor
Farmers Market Location

What other type of business are you interested in?

What's your decision time frame?
Open Within 3 months 3 to 6 months Within the next year More than 1 year away

Approximate amount of investment capital available:
This is a key factor for identifying the right match!

Business Background

Number of years of business experience:
Less than 10 years 10 to 15 years 15 to 20 years 20 to 30 years More than 30 years

Functional/industry areas of experience (Check all that apply):

General Management Sales/Marketing Technical/Engineering Finance/Accounting Human Resources

Manufacturing/Production Operations Distribution/Transportation Professional Services Retail

Average annual personal income (last 3 years):

Typical number of employees/subordinates you directed:

Typical discretionary budget you managed:

Comments/Special Information

Take a moment to review all the information you've entered. If you prefer, you can contact us at 407/647-8580 for a confidential telephone conference. Otherwise, we'll soon be in touch.
Thanks for your time.