Application Instructions

Applicant Information
VCI Program Qualifications

Is the company's headquarters located in Indiana?  
Is the company engaged in any of the following? (check all that apply)
Real estate Accounting Insurance Real estate development
Technology needs Oil or gas exploration Application of new technology Professional motor vehicle racing
Professional services as a lawyer or physician Commercialization of research and development
Retail Sales(Do not check if business is the development or support of electronic commerce using the internet.)

What is the average annual sales of the company in the past two years?  
What is the company's total employment?  
How many of the company's employees reside in Indiana?      
What is the total value of the company's assets?  
What is the value of the company's assets located in Indiana?:      

Site Ownership / Control
The Company certifies appropriate background checks of its principals have been conducted in accordance with common business practices.  

Owner Details
First Name:  
Last Name:  


Percentage of Ownership:  
Address 1:  
Address 2:


Affiliation/relationship to other owners/shareholders/members:
Does the company have an additional owner?