Business Opportunities Questionnaire

Please print out this form and mail it or fax it back to:

99 Kalamath Street
Denver, Colorado 80223-1549
Fax: 630-214-7600

Name __________________________________________________________

Address _________________________________________________________

City/State/Zip _____________________________________________________

Home phone ______________________ Bus. phone _____________________

Business experience _______________________________________________

________________________________________________________________

Business interests __________________________________________________

________________________________________________________________

Available investment _______________________________________________

Decision makers __________________________________________________

Location desired __________________________________________________

When can you commit to a decision for the right business? _________________

_______________________________________________________________

Signed __________________________________________________________

Date __________________________________________