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V V ! v <br /> ELK RIVER BUSINESS INCUBATOR <br /> • APPLICATION FORM <br /> Name of Business: Ver4tca\ 1 k 101 0►►/1j TAlC <br /> Name of Principal: Da(f 7 ' ABY (4 i f 1,e <br /> Address: ��s7� S S�t` �u►��� o?Ofr/j S7L )7Lt1. <br /> Phone: 1/2g2 Fag: <br /> Ownership structure: Sole Proprietorship ❑ <br /> Partnership 0 <br /> Corporation • <br /> (� <br /> Business is primarily involved in: Research and Development 0 <br /> Product Manufacturing/Assembly <br /> Other <br /> Principal product(s): /119ll +e c A No'oil Seryl <br /> • <br /> Activities to be undertaken in the incubator facility: <br /> CoN1/ert P :/1/44 �' c 0.t 1 GN S o n/ /,✓/er/✓- 06/h/ec Caw-felt/14. <br /> Projected number of employees (including principal) at incubator <br /> operation: <br /> Full Time Part Time <br /> Initially 3 / <br /> After 6 months / 7 <br /> At the end of 1 Year 3 Y <br /> At the end of3Years "'R N4 <br />