Office Use Only      Office Code    Initials    SECTION A: PERSON COMPLETING SURVEY   TITLE   Check all categories that apply to the products or services your company provides on the list below. Agriculture Processing E-commerce Financial Service Center Manufacturer Telemarketing/ Call Center Computer or Data Processing Services Engineering or Research Food Processor National Wholesaler Tourism Corporate Services Exporter or Importer High-Tech Service Provider Shared Service Center Other, Please list    Business is Closed. If you checked "Business is Closed", stop here and press exit (located above and to your right).   NEW COMPANY REGISTRATION 1. COMPANY BASICS  Company Name:    AKA/DBA:    Previous Name (if applicable):   Year Est. In Community:   Physical Address:   Mailing Address:  ( same as physical address)    City/State/Zip:     City/State/Zip:     Telephone:   Fax:      format (000) 000-0000    format (000) 000-0000 Web Site:   Email:   2. VALUE ADDED Does your business add value to the product it sells?      Yes    No If yes, briefly describe what your company does to add value to your product(s). 3. MARKET BREAKDOWN State (ND) National (rest of US) TOTAL OF ALL FOUR CATEGORIES SHOULD EQUAL 100% If tourism-related, provide estimates as it relates to revenue source such as the home state or country of visiting tourists. Regional (SD, MT, MN) International (rest of world) Why do we ask this? The more sales you make outside the state, the more new money you are bringing into the state. Your response to this question (and a few others) will help us determine whether you are primary-sector (new wealth-generating) business. It could also make your company eligible for state incentives such as funding assistance and tax exemptions. 4. GROSS SALES What is the annual gross sales amount generated through your North Dakota facility? (Rounding off numbers is acceptable. If this is your first year in operation, please provide projections.)  $  5. VALUE STREAM As a supplier or sub-contractor, what percentage of your value-added product or service is produced for another company(ies) that ultimately sell it outside the state? (Examples: Producing components that another company uses to build a larger or more complicated piece of equipment. Developing software for a company that incorporates it into its final product and sells it nationally such as VARs.)  %   How much of the raw materials or services needed to produce your product is purchased from North Dakota Companies?   %   Companies located outside North Dakota? %     Please list the type of materials or services you cannot currently purchase in North Dakota. 6. LOCAL EMPLOYMENT By Type # Employed Company Growth and Expansion How does total employment compare to the number working in your company 24 months ago? We have more employees than 24 months ago.   Number employees increased   We have fewer employees than 24 months ago.   Number employees decreased   The number of employees has remained the same.   Full Time   Part Time   Leased/Temp   Total   Number of shifts per day:     Number of workdays per week:

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