SUCCESS FORUM QUESTIONNAIRE
All answers will remain confidential.
Full Name
*
First Name
*
Last Name
*
Business Name:
Briefly describe your primary activity:
When was your business founded?
*
Month
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
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30
31
Year
*
Choose One
2011 Revenues
Under 100.000€
100.001€ - 500.000€
500.001€ - 1 million€
1 million€ - 5 million€
Over 5 million€
# of Full Time Employees:
Elaborate on your current resource / expertise needs:
Describe the business milestones you are pursuing
How is your business financed?
Self-financed
Venture Capital
Line of Credit
Business Angel
Other
Submitting this questionnaire does not guarantee that your business will be selected for the Success Forum Series. All answers will remain confidential.
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