New Business Inquiry Form

Individuals who are interested in starting a computer training and testing business should complete and submit the following inquiry form. All information will be treated confidentially.

How did you hear about the Fourth R?
please specify

Contact Person

First Name
Last Name
City State 
Postal Code Country
Best Time to Call

Geographic area of interest: 

Briefly list your educational background (school, degrees, etc.):

Please rate your experience / skill in the following areas:
None Low Average High
Sales and Marketing
Business Operations
Personnel Management
Teaching / Training
Computers and Technology
Current employer and position: 
Previous employer, position and dates:  

Have you ever owned a business before?  Yes No
If yes, please describe: 

Have you filed for bankruptcy in the past 5 years?  Yes No
Do you have any pending lawsuits?  Yes No
Have you ever been convicted of a serious crime?  Yes No

Amount of liquid capital available to invest: 
Approximate net worth: 

Do you plan on having a partner(s)?  Yes No
If yes, please describe: 

Why are you interested in computer training and certification?
What other options are currently being considered?

How soon would you like to start? 



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