eTec - Application

Business Name: Email Address:
Current Business Address:
Street:		Suite No.:
City:		State:	Zip:
Mailing Address (if different):
Street:		Suite No.:
City:		State:	Zip:
Principal Business Owner(s):
Name:
Street:
City:		State:	Zip:
Title:		Phone:



Name:
Street:
City:		State:	Zip:
Title:		Phone:



Name:
Street:
City:		State:	Zip:
Title:		Phone:



Business Status:
Existing Business New Business		Date Started: Projected Start Date:
Business Registered with Secretary of State? Yes No
Federal Employer Tax ID#:		Oklahoma Employer Tax ID#:
Company Structure: Sole Proprietor Corporation Partnership LLC Other
Major Product: Technology Service Professional Public Administration Process Sales Product Other
Nature of Business (Brief description of product/service and nature of market.)
Patent
Initial Capitalization: Less than $10,000 $10,001 to $25,000 $25,001 to $50,000 $50,001 to $100,000 Over $100,000 Sources of Funds: Present Number of Employees: Part-time Full-time Please provide name and phone number of current employees: How many new full and part-time employees do you plan to add over the next two years? Part-time Full-time Explain: Do you have a written business plan? Yes No If yes, please attach a copy in e-mail to etec@etecok.com If no, what is your expected date of completion? If no, do you need assistance in preparing one? Yes No What type of space are you looking for? Office Research/Lab Manufacturing Storage Other (specify)
What are your approximate space requirements?
Office:	square feet
Production	square feet
Storage/Warehouse	square feet
Showroom	square feet
Other (explain below)	square feet
Total square feet needed
Explain Other
What are your projected total space requirements in: One Year total square feet Two Years total square feet Three Years total square feet What is your desired date of occupancy:

List the services you will utilize while occupying space at the eTec:

Copier Fax DSL Mail Handling
Conference Room Technology/Transfer Assistance Audio/Visual Aids
Management Assistance (If yes, what type? i.e. Financing)
Other (specify):

Will you:

Use special laboratory facilities, toxic, corrosive or flammable chemicals?
If yes, Explain:

Have special or high use electrical power requirements attributable to equipment used in your business?
If yes, Explain:

Generate noise which will require soundproofing and/or special partitioning?
If yes, Explain:

Have other special needs or requirements?
If yes, Explain:

Please provide the name, company and phone number of two business references:

Bank:

Why do you wish to locate your business in the eTec and how do you think the eTec can assist you in developing your business? Please provide a short rationale.

Add any additional information that will help the selection committee understand and evaluate your firm's potential for growth and success. Attach additional pages or documents as appropriate.

How did you hear of the eTec?