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The Business has the following character�'stics: <br /> Advances Technology T • <br /> Projects Fast to Moderate Growth er <br /> Medical Related Product/Technology ❑ <br /> Energy Related Product/Technology EV- <br /> If <br /> ✓If Business is a sole proprietorship, indicate principals net worth: <br /> $0 - $24,999 n <br /> $25,000 - $74,999 ❑ <br /> $75,000 - $99,999 ❑ <br /> $100,000 - $200,000 ❑ <br /> Greater than $200,000 n <br /> List the amount of equity you have received to date in the form of stock <br /> ownership 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 ❑ $1,000,000 - $1,500,000 11 <br /> $200,000 - $300,000 ❑ $1,500,000 + up ❑ <br /> List the amount of equity you will require from outside sources over the <br /> period of: <br /> one year in the Business.Incubator $ oo45 <br /> two years in the Business Incubator $ • <br /> The Business is currently in operatio, i Yes ffr No ❑ <br /> Current Location of Business A:4,14-5E-49 / MA) <br /> Number of Years In Operation Sofg.oN rnr S <br /> Current Number of Employees <br /> Most Recent Annual Sales $'.v(-CR 72 B a c.J ( 6i4''£"''-� - <br /> The Business will require approximately econo square feet of space in <br /> the Business Incubator, with the following special needs/requirements: <br /> /rp Setc,.r a C- I k v4 02"...02.400-4 <br /> • <br />