Technology Fast 50 Nomination Form Submission

Company Headquarters
* Company Name:
* Company Address:
* Company City:
Company Phone No:
Company Website:
Past Fast 50 Winner?
Chief Executive Officer
* Full Name:
* Exact Title:
* Email:
Chief Financial Officer
Full Name:
Exact Title:
Email:
Revenues (USD)
* 2006:
* 2007:
* 2008:
* 2009:
* 2010:
Company own proprietary technology or proprietary intellectual property that contributes to a significant portion of your operating revenues?
Month that financial year ends:
Public or Private
Public or Private:
Ticker:
Exchange:
Industry Type
* Industry Type:
Public Relations/Marketing Contact Information
Name:
Title:
Phone:
Extension:
E-Mail:
Contact person
Name:
Title:
Phone:
Extension:
E-Mail:
Disclosure Agreement
Note that yearly revenue figures will be kept confidential whereas the five year revenue growth rate will be public knowledge.