Seminar Registration

Company Name

Company Main Address

Type of Business

Year the Company was Founded

Number of Employees

2017 Revenues
(Please enter financial information below as actual numbers, e.g., 3,500,000 or 475,000)

2017 Profits

2018 Revenues
(Please enter financial information below as actual numbers, e.g., 3,500,000 or 475,000)

2018 Profits

Estimated 2019 Revenues
(Please enter financial information below as actual numbers, e.g., 3,500,000 or 475,000)

Estimated 2019 Net Income

Total Assets

Company Email

Total Debt

Name of Majority Owner(s)

Company website / Facebook page

Desired size of investment
---$100,000 - $500,000$500,000 - $1,000,000$1,000,000 - $1,500,000$1,500,000 - $3,000,000$3,000,000 - $5,000,000Over $5,000,000Desired form of investment
---DebtEquityExport Credit Financing (e.g., US Export Import Bank)Long Term DebtVendor FinancingCombinationOtherWhat will the funds be used for? (required) ---Asset PurchasesChange Currency of Existing DebtLand PurchasesLong Scale Capital InvestmentReduce / Pay off DebtWorking CapitalIs the Company officially registered to do business in Haiti? (required)---YesNoIs Your company a Potential Investee?---YesNoIs Your Company a Haitian SME?---YesNoAre the Company's financials reviewed and/or audited by a CPA (required)---YesNo

Which City would you like to present?AtlantaNew York

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