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* Your current occupation


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   Years in current position


   Describe your business background (previous 10 years)


* What other license/business opportunities are you currently exploring?


* If you are accepted as an Interface Licensee, how much working capital will you devote to your operation?


   What is your approximate Net Worth?


* If you are accepted as an Interface Licensee, how soon are you prepared to commence business??


   If longer than 3 months please specify:


   Is there anything you would like to tell about your business goals?


   Please check which of the following applies to you:


   Why do you feel that you could be a successful Interface Licensee?


* How did you hear about Interface?


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