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410 <br /> 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 ❑ <br /> Greater than $200,000 ❑ <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 ❑ <br /> $100,000 - $200,000 ❑ $1,000,000 - $1,500,000 ❑ <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 $ <br /> two years in the Business Incubator $ <br /> The Business is currently in operation: Yes ❑ No ❑ <br /> Current Location of Business <br /> Number of Years In Operation <br /> Current Number of Employees <br /> Most Recent Annual Sales <br /> The Business will require approximately square feet of space in <br /> the Business Incubator, with the following special needs/requirements: <br /> • <br />