Business Name*

Business Address*

* *

Community name*

If Other, please specify

Business phone*

* x

Primary Contact

First name*

Last name*

Email address*

Contact phone*

How many employees do you have (including yourself)?

What is your primary industry?

11 - Agriculture, Forestry, Fishing and Hunting
21 - Mining
22 - Utilities
23 - Construction
31 - 33 - Manufacturing
42 - Wholesale Trade
44 - 45 - Retail Trade
48 - 49 - Transportation and Warehousing
51 - Information
52 - Finance and Insurance
53 - Real Estate Rental and Leasing
54 - Professional, Scientific, and Technical Services
55 - Management of Companies and Enterprises
56 - Administrative and Support and Waste Management and Remediation Services
61 - Educational Services
62 - Health Care and Social Assistance
71 - Arts, Entertainment, and Recreation
72 - Accommodation and Food Services
81 - Other Services (except Public Administration)
92 - Public Administration *

Would you like your local economic development agency to contact you?

Yes
No *

Please verify that you are a real person*