NAME	COMPANY

ADDRESS 1	ADDRESS 2

CITY	STATE	ZIP
	SELECT ONE --> AL- Alabama AK- Alaska AZ- Arizona AR- Arkansas CA- California CO- Colorado CT- Connecticut DE- Delaware FL- Florida GA- Georgia HI- Hawaii ID- Idaho IL- Illinois IN- Indiana IA- Iowa KS- Kansas KY- Kentucky LA- Louisiana ME- Maine MD- Maryland MA- Massachusetts MI- Michigan MN- Minnesota MS- Mississippi MO- Missouri MT- Montana NE- Nebraska NV- Nevada NH- New Hampshire NJ- New Jersey NM- New Mexico NY- New York NC- North Carolina ND- North Dakota OH- Ohio OK- Oklahoma OR- Oregon PA- Pennsylvania RI- Rhode Island SC- South Carolina SD- South Dakota TN- Tennessee TX- Texas UT- Utah VT- Vermont VA- Virginia WA- Washington WV- West Virginia WI- Wisconsin WY- Wyoming

PHONE	CELL PHONE	FAX

EMAIL ADDRESS

HOW DID YOU HEAR ABOUT HOMETOWN THREADS

HAVE YOU EVER BEEN INVOLVED WITH A COMMERCIAL EMBROIDERY OPERATION? IF YES, FOR HOW LONG?

WHEN ARE YOU PLANNING TO OPEN YOUR BUSINESS?

0 - 6 Months 6 -12 Months 12 - 24 Months Let's discuss it.

WHAT IS YOUR ESTIMATE AMOUNT OF LIQUID CAPITAL?

Less than $20,000 $20,000 - $40,000 $40,000 - $60,000 $60,000 - $80,000 $80,000 - $100,000 More than $100,000

WHAT IS YOUR ESTIMATED NET WORTH (ASSETS MINUS LIABILITIES)?

Under $100,000 $100,000 - $200,000 $200,000 - $300,000 $300,000 - $400,000 More than $400,000

HOW MUCH ARE YOU WILLING TO INVEST IN A COMPLETE TURN-KEY RETAIL EMBROIDERY BUSINESS WITHIN A HIGH TRAFFIC AREA SUCH AS WAL-MART?

$65,000 - $85,000 $85,000 - $100,000 More than $100,000

ARE YOU INTERESTED IN AN ENTIRE DISTRICT, OR JUST ONE STORE? (A HOMETOWN THREADS DISTRICT WILL TYPICALLY BE COMPOSED OF FOUR STORES).

One Store An Entire District

WHEN IS THE BEST TIME TO CONTACT YOU?