Company & Business Proposal Registration & Inquiry Form

Use this form to register or update the registration of your Company, products, service or business proposal in our Business Matching Database.

Registration Category

you may select more than one

Date this form is being filed (e.g., January 1, 1998)

** (required)

Social security number or other identifying number

Full name of person submitting this Registration (e.g John A. Smith)


Business or Company name if any:

Registrant's First Name:


Registrant' Last Name:


Middle Initial:

Email Address:


Internet Website Address

Street Address:


Additional Address:




Zip/Mailing Code (use12345 If no mail code):



Home Telephone #:

( )

Business Telephone #:

( )

Fax Number:

( )


Male Female


Type of Business or Occupation

What trade issue, business or question are you inquiring about:

Describe briefly more details of your business aspirations and plans:

Describe any other business experience you have had:

What product or service that you provide, would you like to list in the database?

What product or service are you specifically interested in finding through the database?

Is your product patented or copyrighted, if not do you plan to patent or copyright it, and where are you in the process?

Are you looking for manufacturing and/or distribution collaboration. Explain.

Have you, or are you interested in licensing your product or certain rights to it. Explain.

If your company is not a publicly traded company, are you interested in becoming a publicly traded entity. Discuss.

If your company is publicly traded already, are you interested in a capital or value infusion, or other assistance? Explain

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