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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 0 <br /> If Business is a sole proprietorship, indicate principals net worth: <br /> $0- $24,999 ❑ <br /> $25,000- $74,999 0 <br /> $75,000- $99,999 0 <br /> $100,000- $200,000 0 <br /> Greater than $200,000 0 <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 0 <br /> $25,000- $74,999 0 $400,000 - $500,000 ❑ <br /> $75,000- $99,999 0 $500,000- $1,000,000 0 <br /> $100,000- $200,000 0 $1,000,000 - $1,500,000 0 <br /> $200,000- $300,000 0 $1,500,000+ up 0 <br /> List the amount of equity you will require from outside sources over the <br /> period of: <br /> one year in the Business Incubator $ a,Dov boo <br /> • two years in the Business Incubator $ NA <br /> The Business is currently in operation: Yes Igj No 0 <br /> Current Location of Business S 13 S Po w m q,1 a e r lila I K �d C o4Ny&i /17/1/ <br /> Number of Years In Operation 0. <br /> Current Number of Employees 3 <br /> Most Recent Annual Sales N/A <br /> The Business will require approximately 2pO'' square feet of space in <br /> the Business Incubator, with the following special needs/requirements: <br /> • <br /> 411 atdd I�'ici✓Gt( /000 v 24Ov 57 Ff w,.// ez/ Fr Fweiirt1 rcw44. <br /> • <br /> Spetce 01(451- b-e acce5ai,1� fo 1,t► t., Fre-e,1 ert/e <br /> 11-cc 5koJI6e cowrffdr4.4IA-/ 9tite - � OCif( CN✓irzwmei- <br /> D � <br />