Your name: ______________________________________________________

Telephone number:________________________________________________

Email address:____________________________________________________

Your relationship to the project
 Investor Principal Officer Intermediary Referring Party
 Other (describe) __________________________________________

A brief description of the project:
  ______________________________________________________________________
  ______________________________________________________________________
  ______________________________________________________________________

Where is the project located? ________________________________________________

Why is the project needed? What value does it add to the local/global economy?
  ______________________________________________________________________
  ______________________________________________________________________
  ______________________________________________________________________ 

What is the monetary value of the entire project? ________________

How much capital is needed? Over what time span? ____________________

When will cash flow from operations be positive (before debt service)? _________________