First Name Last Name Address City State Zip Code Telephone Fax Cell Phone E-mail Spouse's Name     Your Occupation Spouse's Contact Me By: Home Phone Business Phone Cell Phone Email Best Time to Contact Me: Morning Afternoon Evening Where Did You Hear About Us? Have You Owned a Business? Yes No Type? When? How Soon Will You Be Ready to Start Your Business? How Long Have You Been Looking for a Business? Will You Have Partners Other than Your Spouse? Yes No If So, How Many? What Other Businesses Have You Looked At? Which Ones Are You Still Considering? When You Find the Perfect Business, How Much Are You Prepared to Invest? Funds Will Come From: Savings Credit Card Home Equity 401(k) Stock A Combination Other   2008© Business Alliance, Inc.