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The Business has the following characteristics: <br /> Advances Technology ❑✓ <br /> Projects Fast to Moderate Growth <br /> Medical Related Product/Technology <br /> Energy Related Product/Technology <br /> If Business is a sole proprietorship, indicate principals net worth: <br /> $0-- $24,999 <br /> $25,000 - $74,999 ❑ <br /> $75,000 - $99,999 ❑ <br /> $100,000 - $200,000 n <br /> Greater than $200,000 <br /> List the amount of equity you have received to date in the form of stock ownership <br /> and/or direct investment: <br /> $0 - $24,999 $300,000 - $400,000 <br /> $25,000 - $74,999 / $400,000 - $500,000 <br /> $75,000 - $99,999 $500,000 - $1,000,000 n <br /> $100,000 - $200,000 (l $1,000,000 - $1,500,000 [1 <br /> $200,000 - $300,000 ❑ $1,500,000 + up <br /> List the amount of equity you will require from outside sources over the period of: <br /> oneyear in the Business Incubator $ 5.00 k <br /> • two years in the Business Incubator $ /0 vtcfl <br /> The Business is currently in operation: Yes ,.// No n / 0 <br /> Current Location of Business `f7 4 1 MU, 1 '1'1 /? <br /> 7 *I (A,tic, vt oc" 5 S30if <br /> Number of Years In Operation I <br /> Current Number of Employees I FT , PT <br /> Most Recent Annual Sales 4 2-SID _ <br /> The Business will require approximately it square feet of space in the <br /> Business Incubator, with the following special needs/requirements: <br /> -' /000 ✓- f t/o • '- 22002, 1 Q000 '2 -6 k 2 t d Lt i(' 02 <br />