Small Business Community Capital | Indication of Interest Form

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INDICATION OF INTEREST FORM

Thank you for visiting our website!

If you are a company interested in working with us, please feel free to fill out the following form!

Email: Enter Email

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Name of Company: Enter Name of Company

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Work Address: Enter Address

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City: Enter City

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State: Enter State

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Zip code: Enter Zip

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Industry: Enter Industry

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We will review the information you have provided and we will get back to you shortly to discuss your project.

Briefly describe business model (Feel free to enclose marketing materials, summary business plans): Enter Your Message

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Work Phone: Enter Phone Number

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Contact Person: Enter Contact Person

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Title: Enter Title

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Is company at least $1 million in EBITDA?:

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Yes

Are you currently working with corporations? If so, which?: Enter Your Message

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Are you interested in targeting corporations as clients? If so, have you identified which?: Enter Your Message

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What are your expansion, acquisition, owner shift or recapitalization ideas you are contemplating or would like to further explore?: Enter Your Message

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Do you have an estimation of how much capital and what type of capital (debt, equity or mezzanine) will you require?: Enter Your Message

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Any other information you wish to add?: Enter Your Message

Web Site: Enter Website

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Image Verification:

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Please verify the above fields are filled correctly so that the form is sent.

INDICATION OF INTEREST FORM

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