APPLICATION FOR SUITE AT THE CRC
TENANT
INFORMATION
Name: Dr. Mr. Ms. ___________________________________ Date:
_______________
Company Legal Name: ___________________________ Web Site:
_______________________
Address:
_________________________________ City: ____________ State: _____ Zip: ____
Permanent Address:
Description of the company’s products or
services:
_______________________________________
________________________________________________________________________________
Type of Business:
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Biotechnology |
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Internet/Telecommunications |
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Computer Science |
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Library Science |
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Electronics |
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Materials and/or Chemistry |
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Engineering and Design
Automation |
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Transportation |
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Environmental |
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Tech Transfer/Assistance |
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Other
_______________________________ |
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Desired Occupancy Date: __________________ Desired Lease Term:
____________________
Desired Company Name on Signage:
_________________________________________________
Desired number of building keys: ____________ Office
keys: ___________________________
Initial Number of Employees: _________ Full-time __________ Part-time
Special Upfit
Features (if any):
______________________________________________________
COMPANY
INFORMATION
Type of business: S-Corp C-Corp
LLC
Partnership
Sole-Proprietorship
Federal ID Number: __________________ or Social Security No.: ________________________
State of
Bank:
_______________________
Company President: ___________________________
Credit References: (Include a contact name
and phone number)
1) ___________________________ _________________________
2) ___________________________ _________________________
3) ___________________________ _________________________
Application must be accompanied by a
financial statement of the company. Make
application for telecom services at www.vtcrc.net.
Incorporation Date: ________________ Signature:
__________________________________
Spouse’s Name: ___________________ Title:
______________________________________