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Application Instructions
Applicant Information
VCI Program Qualifications
Is the company's headquarters located in Indiana?
Yes
No
* Required
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?
* Required
What is the company's total employment?
* Required
How many of the company's employees reside in Indiana?
* Required
What is the total value of the company's assets?
* Required
What is the value of the company's assets located in Indiana?:
* Required
Site Ownership / Control
The Company certifies appropriate background checks of its principals have been conducted in accordance with common business practices.
Yes
No
* Required
Owner Details
First Name:
* Required
Last Name:
* Required
Email:
* Required
Invalid E-Mail Address
Telephone:
* Required
Fax:
Percentage of Ownership:
* Required
Address 1:
* Required
Address 2:
City:
* Required
County:
* Required
State:
select
AL
AK
AS
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
* Required
Zip:
* Required
Invalid Zip Code
Affiliation/relationship to other owners/shareholders/members:
* Required
Does the company have an additional owner?
Owner 2 Details
First Name:
* Required
Last Name:
* Required
Email:
* Required
Invalid E-Mail Address
Telephone:
* Required
Fax:
Percentage of Ownership:
* Required
Address 1:
* Required
Address 2:
City:
* Required
County:
* Required
State:
select
AL
AK
AS
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
* Required
Zip:
* Required
Invalid Zip Code
Affiliation/relationship to other owners/shareholders/members:
* Required
Does the company have an additional owner?
Please upload documentation listing any additional owners/shareholders/members:
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