Alternate Sources - Enrollment Form

Name

Address

City

State/Province Zip/Postal

Telephone (use no dashes) Ext. Cell

E mail address

Other Information

My plans are for...

a childrens fun center ages infant to 12 years (approx.)

a family entertainment center, catering to all ages.

I estimate the total budget to open my facility will be...

$200,000 or less

$200,000 - 350,000

$350,000 - 500,000

$500,000 - 750,000

$750,000 - $1 million or more

My access to capital is...

none

5% - 10% of the total budget

10% - 15% of the total budget

15% - 20% of the total budget

20% - 30% of the total budget

More than 30%

Location / Site...

I am looking to lease a site.

I am looking to buy / build my perfct site.

I do not have a site in mind, and am currently looking for one.

I have found the perfect site, but have not yet secured it.

I am...

just starting out, working on my business plan.

nearly completed my business plan.

finished my business plan and just beginning the search for funding.

finished my business plan and have been looking for funding for awhile.

completely frustrated and have exhausted all local avenues of funding.

The Alternate Sources of Funding database includes a wide variety of people. Please provide us with any additional information that may help us in finding the right match, ie; Background, interest in providing specific activities or events, size of facility, etc. Once completed and submitted we will give you a call to confirm.

Thank you for your enrollment. Once your payment has been received, please allow 1 business day for your request to be processed. You will be contacted to verify your participation.