Fact Sheet - Member
Fact Sheet - Member
Please print out this form and mail it or fax it back to:
99 Kalamath Street
Denver, Colorado 80223-1549
Fax: 630-214-7600
1. Name of Business ___________________________________________________
2. Address __________________________________________________________
3. City and State _____________________________________________________
4. Telephone ________________Fax ______________Email _________________
5. Contact(s) ________________________________________________________
6. Type of Business _______________________ SIC Code ___________________
7. Year Established _________ Type of Organization ________________________
8. Daily Volume ______________________ Weekly Volume _________________
9. Monthly Volume _____________________ Annual Volume ________________
10. Key Staff Members ________________________________________________
11. Biggest Challenge:
A. ________________________________________________________________
B. ________________________________________________________________
C. ________________________________________________________________
12. Goals:
A. One Month _______________________________________________________
B. One Year _________________________________________________________
C. Three Year _______________________________________________________
13. Major Customers:
A. ________________________________________________________________
B. ________________________________________________________________
C. ________________________________________________________________
D. _______________________________________________________________
E. ________________________________________________________________
14. Bank ___________________________________________________________
15. Insurance _______________________________________________________
16. Lawyer _________________________________________________________
17. Accountant ______________________________________________________
18. Advertising Agency _______________________________________________
19. Printing ________________________________________________________
20. Major Suppliers _________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
21. Comments ______________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
22. Date ______________________ By _________________________________