We recommend reviewing the process below before completing the application.
Provide complete information. Insert "N/A" in boxes that do not apply."
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Home Address
City State Zip Code
Home Phone Mobile Phone
Primary Email Address Second Email Address
Applicant's Legal Business Name
Current Business Location: City State Zip Code Type Of Business Indicate principle line of merchandise sold; specific work/service offered; products produced: Type of Entity: Sole Proprietor C or S Corporation Organization Partnership Nonprofit Organization If a corporation, name the state or foreign country where incorporated: Employer Identification Number (if applicable) Number of Employees: Full-time Part-time Reason For Applying: Starting A New Business Expanding An Existing Business Stage of Development: Idea Stage Early Stage Prototype Stage Development Stage Expansion Stage Date Business Started or Date Business will Start: (Month, Day, Year) Is this a Minority or Woman-Owned business? Briefly describe your background and experience: How can your product or service be protected? Patent Trademark Copyright Other Primary Source of Financing: Savings Operating Income Debt-Personal Debt-Bank Equity Investment-Venture Capitol Current Capital: $0 - $1,000 $1,000 - $5,000 $5,000 - $10,000 Total Assets Total Liabilities Total Revenue(past 12 months) Annual Growth Rate (%): Anticipated Staffing (within 1yr, 2yrs, 3yrs) (Part, Full, Indirect): How did you hear about us? List any affiliation, subsidiary, or parent company relationship which impacts your the business: (if more than one, please attach a separate page providing the following information): Legal Name: Relationship to Applicant's Business: State of Organization: Address City State Zip Code Principals/Officers Information: Principal/Officer 1: Information: -Name Title -% Owned (Explain) -Full / Part-Time -Address -Phone Fax Email Principal/Officer 2: Information: -Name Title -% Owned (Explain) -Full / Part-Time -Address -Phone Fax Email Principal/Officer 3: Information: -Name Title -% Owned (Explain) -Full / Part-Time -Address -Phone Fax Email
Type Of Business
Indicate principle line of merchandise sold; specific work/service offered; products produced:
Type of Entity: Sole Proprietor C or S Corporation Organization Partnership Nonprofit Organization
If a corporation, name the state or foreign country where incorporated:
Employer Identification Number (if applicable)
Number of Employees: Full-time Part-time Reason For Applying: Starting A New Business Expanding An Existing Business Stage of Development: Idea Stage Early Stage Prototype Stage Development Stage Expansion Stage Date Business Started or Date Business will Start: (Month, Day, Year) Is this a Minority or Woman-Owned business? Briefly describe your background and experience: How can your product or service be protected? Patent Trademark Copyright Other Primary Source of Financing: Savings Operating Income Debt-Personal Debt-Bank Equity Investment-Venture Capitol Current Capital: $0 - $1,000 $1,000 - $5,000 $5,000 - $10,000 Total Assets Total Liabilities Total Revenue(past 12 months) Annual Growth Rate (%): Anticipated Staffing (within 1yr, 2yrs, 3yrs) (Part, Full, Indirect): How did you hear about us? List any affiliation, subsidiary, or parent company relationship which impacts your the business: (if more than one, please attach a separate page providing the following information): Legal Name: Relationship to Applicant's Business: State of Organization: Address City State Zip Code Principals/Officers Information: Principal/Officer 1: Information: -Name Title -% Owned (Explain) -Full / Part-Time -Address -Phone Fax Email Principal/Officer 2: Information: -Name Title -% Owned (Explain) -Full / Part-Time -Address -Phone Fax Email Principal/Officer 3: Information: -Name Title -% Owned (Explain) -Full / Part-Time -Address -Phone Fax Email
Reason For Applying: Starting A New Business Expanding An Existing Business
Stage of Development: Idea Stage Early Stage Prototype Stage Development Stage Expansion Stage
Date Business Started or Date Business will Start: (Month, Day, Year)
Is this a Minority or Woman-Owned business?
Briefly describe your background and experience:
How can your product or service be protected? Patent Trademark Copyright Other
Primary Source of Financing: Savings Operating Income Debt-Personal Debt-Bank Equity Investment-Venture Capitol
Current Capital: $0 - $1,000 $1,000 - $5,000 $5,000 - $10,000
Total Assets Total Liabilities Total Revenue(past 12 months) Annual Growth Rate (%): Anticipated Staffing (within 1yr, 2yrs, 3yrs) (Part, Full, Indirect): How did you hear about us? List any affiliation, subsidiary, or parent company relationship which impacts your the business: (if more than one, please attach a separate page providing the following information): Legal Name: Relationship to Applicant's Business: State of Organization: Address City State Zip Code Principals/Officers Information: Principal/Officer 1: Information: -Name Title -% Owned (Explain) -Full / Part-Time -Address -Phone Fax Email Principal/Officer 2: Information: -Name Title -% Owned (Explain) -Full / Part-Time -Address -Phone Fax Email Principal/Officer 3: Information: -Name Title -% Owned (Explain) -Full / Part-Time -Address -Phone Fax Email
Total Revenue(past 12 months) Annual Growth Rate (%):
Anticipated Staffing (within 1yr, 2yrs, 3yrs) (Part, Full, Indirect):
How did you hear about us?
List any affiliation, subsidiary, or parent company relationship which impacts your the business: (if more than one, please attach a separate page providing the following information):
Legal Name:
Relationship to Applicant's Business: State of Organization: Address City State Zip Code Principals/Officers Information: Principal/Officer 1: Information: -Name Title -% Owned (Explain) -Full / Part-Time -Address -Phone Fax Email Principal/Officer 2: Information: -Name Title -% Owned (Explain) -Full / Part-Time -Address -Phone Fax Email Principal/Officer 3: Information: -Name Title -% Owned (Explain) -Full / Part-Time -Address -Phone Fax Email
Address City State Zip Code Principals/Officers Information: Principal/Officer 1: Information: -Name Title -% Owned (Explain) -Full / Part-Time -Address -Phone Fax Email Principal/Officer 2: Information: -Name Title -% Owned (Explain) -Full / Part-Time -Address -Phone Fax Email Principal/Officer 3: Information: -Name Title -% Owned (Explain) -Full / Part-Time -Address -Phone Fax Email
Principals/Officers Information:
Principal/Officer 1: Information:
-Name Title -% Owned (Explain) -Full / Part-Time -Address -Phone Fax Email Principal/Officer 2: Information: -Name Title -% Owned (Explain) -Full / Part-Time -Address -Phone Fax Email Principal/Officer 3: Information: -Name Title -% Owned (Explain) -Full / Part-Time -Address -Phone Fax Email
-% Owned (Explain)
-Full / Part-Time
-Address
-Phone Fax Email
Principal/Officer 2: Information:
-Name Title -% Owned (Explain) -Full / Part-Time -Address -Phone Fax Email Principal/Officer 3: Information: -Name Title -% Owned (Explain) -Full / Part-Time -Address -Phone Fax Email
Principal/Officer 3: Information:
-Name Title -% Owned (Explain) -Full / Part-Time -Address -Phone Fax Email
The OITC Administration
