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So that we better get acquainted and build together a real project, we thank you for responding to this questionnaire. This information will remain confidential.

Identity

Family name * :

First name * :

Address * :

Zip code - City * :

Professional tel. * :

Personal tel. * :

E-mail * :

Family

Marital status :

Single Married Divorced

Family name and first name of partner :

Age * :

Establishment

City and location desired :

Reasons for your choice :

Do you have premises ? :

Oui Non

If yes, Surface exhibition :

Oui Ml vitrine

Do you intend to devote your time to this activity ?

Financial capacity

Funds mobilized for the project (short or medium term) :

Estimated personal wealth :

Loans outstanding :

Desired start date :

Any personal comments :

Verification code * :

Please complete all required fields

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