Company Name:

Contact Name:

Title:

Address:

City:

Postal Code:

State/Province:

Email Address:

Phone:

No. Employees:

Annual Revenue:

Private held? Public?

Year Founded:

URL:

Proposal Description

Please give a brief description of your proposed partnership with Activeworlds Inc.:

Please tell us how you think your product or service compliments those of Activeworlds Inc.?