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  1. TARGETED MONEY SOURCES SEARCH APPLICATION
  2. (For Items 2 thru 6 Simply Attach Business Card)
  3.  
  4. []  1. Date:
  5. []  2. Name:
  6. []  3. Company:
  7. []  4. Address:
  8. []  5. City/State/Zip:
  9. []  6. Day Phone:
  10. []  7. Financing Purpose:
  11. []  8. Financing Type (Check One Item):
  12.        [] Start-Up (Venture Capital/SBIC)
  13.        [] Accounts Receivables
  14.        [] Factoring
  15.        [] Inventory
  16.        [] Equipment/Machine & Leasing
  17.        [] Purchase Order (Vendor)
  18.        [] Buyout/Acquisition
  19.        [] Turnaround
  20. []  9. Investment Location:
  21. [] 10. Financing Amount:  $_________
  22. [] 11. Industry Type (Check One):  
  23.        [] Communications
  24.        [] Manufacturing
  25.        [] Distribution
  26.        [] Wholesale Trade
  27.        [] Retail Trade
  28.        [] Insurance
  29.        [] Real Estate
  30.        [] Finance/Banking
  31.        [] Construction
  32.        [] Business Services
  33.        [] Transportation
  34.        [] Medical
  35.        [] Computer
  36.        [] Electronics
  37.        [] Existing Technologies
  38.        [] New Technologies
  39.        [] Natural Resources       
  40. [] 12. Mail this completed application with $50 fee (Check or 
  41.        Money Order) for targeted money search service to:  Tom 
  42.        Welch, POB 791555-148, San Antonio, TX 78279