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• ELK RIVER ECONOMIC DEVELOPMENT <br /> TECHNOLOGY ASSISTANCE PROGRAM <br /> APPLICATION FORM <br /> .11111A11=7 <br /> Name of Business: <br /> Name of Principal: <br /> Address: Phone: <br /> Fax: E-mail: <br /> Business is primarily involved in: Research and Development ❑ <br /> Product Manufacturing/Assembly ❑ <br /> Other ❑ <br /> Principal product(s): <br /> Number of Years in Operation: <br /> • Current Number of Employees: <br /> Most Recent Annual Sales: <br /> Technology Assistance Program Service Requested: <br /> Program Cost: <br /> Objective: <br /> Commitment for Growth in Elk River <br /> Expected Jobs Created and/or Retained: <br /> Expected Equipment Purchase: <br /> New Construction/Remodel/or Expansion Time Frame: <br /> Other: <br /> Signature: <br /> • Printed name: <br /> Company name: <br /> Date: <br />