Business Name:
*
Principal Officer(s)
*
Phone:
*
Fax:
Email:
*
Business Address:
Form of Ownership:
(must pick one)
LLC
S-Corp
C-Corp
Sole Proprietorship
Partnership
Not incorporated
*
Nature of Business: (brief description of product/service and nature of market)
Submit product brochures and company literature, if available, to the email address listed at the bottom of this form.
Brief Background of Principal Officer(s):
Attach Resume:
Date Established:
Current Status of Business (e.g. working on prototype, product in advanced development)
Current Sales Revenue (please indicate dollar volume per month):
Number of Employees (include principal officers)
Full-Time:
Part-Time:
Projected number of employees within 12 months:
Type of financing used to operate business to date:
please select ...
Private Investors
Venture Capital Firms
Other
Personal Resources
If Other, indicate Nature:
Status of Business Plan:
Do You Need Help Writing a Business Plan?
Approximate Space Requirements (if any)
Sq. Feet for Office:
Other (specify here):
Special Facility Requirements (electrical, ventilation, floor load, etc.):
Approximate Date You Desire To Occupy Space:
Desired Date:
After you submit the application, please include the following items via email or U.S. mail:
Business Plan or Summary
Company and Product Literature
Management Team Biographies
Email to: brad.proctor@daytonrcc.com or mail to:
Bradley Proctor, Executive Director
