ENTREPRENEURS SEEKING ASSISTANCE
(The following should be completed by the entrepreneur, authorized officer, or representative -- not by a facilitator.)

PLEASE READ FOLLOWING DISCLAIMER

Do you understand that you are not allowed to advertise for investors and that none of the information you provide will be published on this site to attract investors?

Check -Yes - to proceed

You should also understand that it is your responsibility to determine if you may accept money as a loan, from sale of shares or other interest in your Company. No fee is being charged you. This information may (without disclosing your name or proprietary information) be summarized and provided to investors if allowable by SEC regulations and/or State laws. We will have no obligation to assist you in seeking loans or equity capital, but will review the information you provide and provide advice to the extent we feel is appropriate.

FORM TO BE COMPLETED BY ENTREPRENEURS


Do you understand that you are not allowed to advertise for investors and that none of the information you provide will be published on this site to attract investors?

Check -Yes - to proceed

You should also understand that it is your responsibility to determine if you may accept money as a loan, from sale of shares or other interest in your Company. No fee is being charged you. This information may (without disclosing your name or proprietary information) be summarized and provided to investors if allowable by SEC regulations and/or State laws. We will have no obligation to assist you in seeking loans or equity capital, but will review the information you provide and provide advice to the extent we feel is appropriate.

FORM TO BE COMPLETED BY ENTREPRENEURS

ENTREPRENEUR'S REAL NAME
COMPANY NAME
YOUR E-MAIL ADDRESS
STREET ADDRESS
CITY
STATE
ZIP CODE
YOUR PHONE NUMBER
   
PROVIDE INFORMATION ABOUT YOUR COMPANY OR YOUR PLANS TO ESTABLISH A BUSINESS 5.