Applicant Name (required)

Your Email (required)

General Information

Date

Company Name

Project Name (if applicable)

Company Street Address

City

State

ZIP

Company Phone

FAX

Company Website

Company Contact Name

Contact Title

Contact Phone

Contact Email

Company Tax/Accountant Contact Name

Contact Title

Contact Phone

Contact Email

Company Ownership Structure

Project Type

Describe company's projects, products or services:

Projected New Capital Investment

(Do not combine years except in the "Total" section.)

Year One

Real Property

Machinery/Equipment

Other Personal Property

Transferred Equipment

Year Two

Real Property

Machinery/Equipment

Other Personal Property

Transferred Equipment

Year Three

Real Property

Machinery/Equipment

Other Personal Property

Transferred Equipment

Year Four

Real Property

Machinery/Equipment

Other Personal Property

Transferred Equipment

Year Five

Real Property

Machinery/Equipment

Other Personal Property

Transferred Equipment

Total

Total Real Property Investment

Total Machinery/Equip. Investment

Total Other Personal Property Investment

Total Transferred Equipment Investment

Projected Labor Requirements

(Do not combine years except in the "Total" section.)

Year One

Production
Maintenance
Office
Management

Year Two

Production
Maintenance
Office
Management

Year Three

Production
Maintenance
Office
Management

Year Four

Production
Maintenance
Office
Management

Year Five

Production
Maintenance
Office
Management

Total Jobs

Production
Maintenance
Office
Management

Starting wage/hr. new-hire production employee

Average wage/hr. existing production employee

Starting wage/hr. new-hire maintenance employee

Average wage/hr. existing maintenance employee

Starting wage/hr. new-hire office employee

Average wage/hr. existing office employee

Starting wage/hr. new-hire management employee

Average wage/hr. existing management employee

Number of new, full-time jobs with annual salary/wages of $35,000 or more

If an existing TN company, what is current employment at present location?

Project Information

What type of local incentives is this project seeking

List the direct and indirect benefits of this project to the community

List any other information that should be considered regarding this project

Digital Signature

Please check to sign this application