company name

company contact name

type of corporation

please check the box that applies to your business:
minority-owned business enterprise (MBE)
woman-owned business enterprise (WBE)
SBA 8(A) certified business enterprise

current address

phone

email address

description of business and products, or services offered

list of officers / directors (please provide full names and a phone or email address)

current number of employees

projected number of employees in 2 years

space requirements (sq. ft.)

target date for locating within the incubator

technology focus

required support services from incubator (business & technical)

special facility requirements (electrical, ventilation, floor load, etc)

internet service needs

a business plan is required with this application.
do you need assistance in developing a business plan?

additional comments

federal id number

THREE (3) CREDIT REFERENCES
(please provide company name, contact name, address, and phone number)

credit reference #1

credit reference #2

credit reference #3

bank information
(please provide bank name, account description, address, and phone number)