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* 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?
No
Yes, by appointment
Yes, 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
:
ND
ND
AB
AK
AL
AR
AZ
BC
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MI
MN
MO
MS
MT
NB
NC
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
QC
RI
SC
SD
SK
TN
TX
UT
VA
VT
WA
WI
WV
WY
YT
City/State/Zip
:
ND
ND
AB
AK
AL
AR
AZ
BC
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MI
MN
MO
MS
MT
NB
NC
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
QC
RI
SC
SD
SK
TN
TX
UT
VA
VT
WA
WI
WV
WY
YT
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?
Yes
No
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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North Dakota Department of Commerce
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Bismarck, ND 58503 | 701.328.5300
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