DC Evans and Company, LLC

Private Placement Specialists

About Us	Need Growth Capital?	What's a Private?		Investor Questionnaire		Contact Us

Thank you for filling out the form below.
	(a) Name(s)
	(b) State of Residence
	(c) Do you individually or jointly with your spouse have net worth in excess of $1,000,000 (include home, autos, furniture, and so on).
	(d) Did you have income in excess of $200,000 in each of the past two calendar years, and do you plan to have that level of income this year? ($300,000 if joint with spouse).
	(e) E*Mail
	(f) Telephone Number