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• The Business has the following characteristics: <br /> Advances Technology 1] <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 in the form of stock ownership and/or direct <br /> 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 (1 <br /> $200,000 - $300,000 ❑ $1,500,000 + up ❑ <br /> List the amount of equity you would require over the period of: <br /> one year in the business incubator $ <br /> years in the business incubator $ <br /> • two <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 square feet of office space, and <br /> square feet of warehouse/storage space in the incubator facility, with the <br /> following special needs/requirements: <br />