2. Type of Institution

Investment Group
Venture Capitalist
Broker/Dealer
Bank
Asset Based Lender
Institutional Investor
Accounts Receivables Factor
Medical Receivables Factor
Pension Fund
Mutual Fund
Other, Please specify:

3. Service Offering/Description

A. Describe services offered by your company:

B. Indicate the type and stage of funding provided by your firm (i.e., equity, debt, business loans for expansion, working capital, etc.) :

C. Geographic locations of interest (including international):

D. Specify your investment/funding criteria (i.e., industry group(s), sales, profitability, years in business, cashflow, etc.):

E. What size of investment or funding do you prefer: :
Minimum investment amount ($US)
Maximum investment amount ($US)

F. What are your fee arrangements?

G. Other comments, information, requests, instructions, etc:

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