INFORMATION FORM     Last Name                               First Name                               Middle Name                            Registered Business                             Name 1)                                             2)           Type of Business       Ownership                            Capitalization                           Current Address                       State                           Country                                    Business Address                    Home Number                            Office Number                            E-mail Address                         URL         Nature of Business            Major Activity      Minor Activity     Principal Products                    Minor Products                         Number of Employees              Target Market                          Age Group                               Remarks                                  Action                                              (Note: All Fields in RED are required.)
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