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• ELK RIVER BUSINESS INCUBATOR <br /> APPLICATION FORM <br /> Name of Business: K V10 W le d Coy'p rot )\oN. <br /> Name of Principal: -TOS,e i0k C, K b(A S (Av- <br /> Address: to / ) t,t) 1-1 L A vilovev' v S-5-30474. <br /> Phone: (6(i ) 7 70- _2 2 3 7 Fax (76 3 3 2 7-2 <br /> Ownership structure: Sole Proprietorship ❑ <br /> Partnership ❑ <br /> Corporation <br /> _Cut .b '"c <br /> Business is primarily involved in: Research and Development <br /> Product Manufacturing/Assembly <br /> Other <br /> Principal product(s): ;5YL dome, illZS YL Poky Io�r <br /> L <br /> A ELI — kvlowtedsv rpr vDu, l,J/ ev►(1i 11 Ctlyt ...Pm <br /> Activities to be undertaken in the incubator facility: Q vtS t r(BScGGV ` <br /> LAS i,t1,55 4001.-6 ( vt1t, -:GL bto I o C' Lora '✓L <br /> Pro to OI.E'< (of vimi4 L�.S t/t GG c <br /> Projected number of employees (including principal) at incubator operation: <br /> Full Time Part Time <br /> Initially 2 `f <br /> After 6 months <br /> At the end of 1 Year 2,c �f <br /> At the end of 3 Years <br />