Economic Development and Finance: New Company

New Company Information

* Person Completing This Form:
* Name:	(First Name, MI, Last Name)
* Title:
* Email:

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
Computer or Data Processing Services	Engineering or Research	Food Processor	National Wholesaler
Corporate Services	Exporter or Importer	High-Tech Service Provider	Shared Service Center
Telemarketing/Call Center	Tourism	Other

Public Tours

Does your busienss provide tours to the public?

NoYes, by appointmentYes, at a daily scheduled time

Company Information

* Company Name:		AKA/DBA:
Previous Name:		Year Est. in Community
			(same as mailing address)
Mailing Address		Physical Address:
City/State/Zip:		City/State/Zip:
Telephone:	format (XXX) XXX-XXXX	Fax	format (XXX) XXX-XXXX
Web Site:		Email

Value Added

Does your business add value to the product it sells? YesNo

If yes, briefly describe what your company does to add value to your product(s).

Market Breakdown

Total of all four categories should equal 100%
State (ND) (numeric value)	Regional (SD, MT, MN) (numeric value)	National (Rest of US) (numeric value)	International (Rest of World) (numeric value)
If tourism-related, provide estimates as it relates to revenue source such as the home state or country of visiting tourists.
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.

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.) $

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? % (numeric value)

Companies located outside North Dakota? % (numeric value)

Please list the type of materials or services you cannot currently purchase in North Dakota.

Local Employment

By Type	# Employed
* Full Time
* Part Time
* Leased/Temp
* Total

If you do not redirect to a "Thank You" page, please review the information above to ensure you have provided all the needed information.
Information needed to complete the submission will be noted in red.


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