Basic Information
First Name *
Last Name *
Email *
Phone *
Street *
City *
State *
Zip *
Name(s) of your business partner(s) on this project *
Are you presently subject to an indictment, criminal information, arraignment, or other means by which formal criminal charges are brought in any jurisdiction, or presently incarcerated, on probation or parole? *
Have you or your business partner(s) ever declared bankruptcy? *
Within the last 7 years, for any felony or misdemeanor for a crime against a minor, have you: 1 been convicted; 2 pleaded guilty; 3 pleaded nolo contendere; 4 been placed on pretrial diversion; or 5 been placed on any form of parole or probation including *
Do you personally have any financial obligations or liabilities as a result of a court order such as divorce proceedings, judgments, or other civil/criminal order? *
If you answered yes to any of the above four questions, please describe below: *
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