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ELK RIVER BUSINESS INCUBATOR <br /> • APPLICATION FORM <br /> Name of Business: �NTA`G/ 7Z'Dc- O.Vs TNc. <br /> Name of Principal: 10/9 ZX <br /> Address: X 3 3// ,VVI / �/�/il/C.�TJr� /�.sd s-5-3-2/ <br /> Phone: /7---3c) --297 Es Fax: 763— 1 9- 7 <br /> Ownership structure: Sole Proprietorship ❑ <br /> Partnership 0 <br /> Corporation ( ' <br /> Business is primarily involved in: Research and Development <br /> Product Manufacturing/Assembly 0 <br /> Other 0 <br /> Principal product(s): C'dverl� ik/r4r'4 QS <br /> • <br /> Activities��// to be undertaken in the incubator facility: <br /> Projected number of employees (including principal) at incubator <br /> operation: <br /> Full Time Part Time <br /> Initially <br /> After 6 months 4/ •-' / <br /> At the end of 1 Year l( / <br /> • At the end of 3 Years <br />