Sample Application Form
1) Name of Company:
2) Current Address:
2a) City:
2b) State:
2d) Zip Code:
2e) Country:
3) Contact Person for Application:
3a) Title:
3b) Phone:
3c) Fax:
3d) E-mail Address:
3e) Is Address the Same as Company? (Y/N)
If No, Please Provide the Contact's Address:
4) Please Provide a Brief Description of the Company:
6) NAICS Code:
6a) If NAICS Code Unknown, Please Describe Primary Line of Business:
7) Please Describe the Public Incentive/s That You Are Seeking:
7a) Please Provide a Brief Description as to Why You Are Seeking These Incentives:
8) Is Your Firm Relocating or Expanding?
	note: if an expansion, please proceed to question 11
9) Please Let Us Know Why You are Considering Lawrence for Relocation:
10) Will This Relocation Involve Your Whole Company or Part?
10a) If Part, Please Describe the Primary Business Activity of the Relocation:
10b) Is this the same type of business as your firm overall? (Y/N)
11) For Expansion, Briefly Describe the Purpose and Activities of the New Facility:
12) When Do You Plan to Begin Operation of the New Facility:
13) How Many Employees Currently Work in Lawrence (0 for Relocation)?:
13a) How Many Will Work in Lawrence After Expansion/Relocation:
13b) How Many Employees Do You Anticipate Hiring from Outside the
	Local Labor Market?
13c) How Many do You Plan to Hire or Relocate from Outside Kanas?
14) Current Operating Expenditures per Year (Enter 0 for Relocation):
14a) Operating Expenditures After Expansion/Relocation:
14b) Estimated % of Additional Expenditures Made in Lawrence:
15) Please Provide an Estimate of Anticipated Annual Gross Profits ($):
	(note, for expansions, please enter anticipated gross annual profits from expansion)
16) What is the Size of the New Facility Being Constructed (square feet)?
	If an Expansion, Please Enter Size of the Current Building (sqare feet):
16) What is the Estimated Value of the New Construction (Excluding Land)?
17a) Size of the Parcel on Which the Building Will be Located (acres):
17b) What is the Value of the Land (0 if Leased)
17c) What is the Lease Rate for the Land (per month):
18) About What % of New Goods Produced in Lawrence, Will Be Sold
	Outside of Lawrence and/or Douglas County:
18a) Of Goods Currently Produced, About What % Are Sold In Lawrence:
19) Please Provide a Breakdown of Employees Hired and Average Salary, by Year:
	Year	New Employees	Average Salary	Building Investment
	1
	2
	3
	4
	5
	6
	7
	8
	9
	10
20) Please Provide the Following Information on Benefits:
	% Health Care Covered
	% of Employees with Company Health Care
	% of Employees with Retirement Program
20a) Will You Provide Job Training for Employees? (Y/N)
20b) If Yes, Please Describe:
20c) What is the Lowest Hourly Wage Offered to New Employees?
20d) What Percentage of Your New Employees Will Receive this Wage?
21) Will You Provide Additional Benefits to Employees? (Y/N)
21a) If Yes, Please Describe:
22) How Much do You Currently Pay, on Average, for the Following Utilities Each Month:
	a) Gas
	b) Electricity
	c) Cable Television
	d) Telphone Service
23) Will the Building Meet Energy STAR Criteria: (Y/N)
24) Will the Building Seek LEED Certification: (Y/N)
24a) If You Will Seek LEED Certification, What Level Will You Seek:
	(Certified/Silver/Gold/Platinum)
25) Please describe any environmental impacts, positive or negative, your operations have
as well as any remedial actions your firm may take to address negative impacts:
26) Please describe any additional benefits or costs you believe your busines will bring
	to the City of Lawrence and Douglas County, KS: