Business Name:
	Street Address:
	City:
	State:
	Zip Code:
	Telephone:
	Fax:
	Email:

	Business Description	Distribution Channels:
	Company Background:	Competition:
	Products/Services:	Management:
	Technologies/Special Know-How:	Number of Employees:
		Auditor:
		Law Firm:
		Bank:
	Markets:	Current Investors:
		Amount:
		Amount of Financing Sought :
	Industry:	Use of Funds:

Fiscal Year End
	Year 1 Projection	Year 2 Projection	Year 3 Projection
Revenue
EBIT*

* Earnings Before Interest and Taxes