Business Licensing & Registration Survey

Company Information

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* 1. Please tell us about your company

Business Contact: *

Company Name: *

Address: *

Address 2:

City/Town: *

State: *

ZIP: *

Country:

Email Address: *

Phone Number: *

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* 2. Which of the following best describes the industry sector in which your business operates?

	Arts & Culture	Knowledge Based & Technology	Green	Media	Tourism	Manufacturing	Retail	Construction, Real Estate,Transportation & Warehousing	Health Care & Educational Services
Industry Sector	Industry Sector Arts & Culture menu	Industry Sector Knowledge Based & Technology menu	Industry Sector Green menu	Industry Sector Media menu	Industry Sector Tourism menu	Industry Sector Manufacturing menu	Industry Sector Retail menu	Industry Sector Construction, Real Estate,Transportation & Warehousing menu	Industry Sector Health Care & Educational Services menu

Industry Sector not listed (Please specify)

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* 3. Product or service of your company

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* 4. Please describe the business activities:

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* 5. Years in Business

Number of Years in Business:

Start-up:

Year Established

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* 6. Where do you sell the majority of your product (s) or service (s)?

Local

Outside of City

State

National

International

Percentage % (please specify)

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* 7. How many people does your business or organization employ?

0-4 Employees

5-20 Employees

21-49 Employees

50-249 Employees

250-499 Employees

500 or more Employees

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* 8. What was your total payroll for the most recent fiscal year?

Less than $100,000

$100,000 - $500,000

$500,000 - $1 Million

$1 - $5 Million

$5 - $25 Million

More than $25 Million

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* 9. Number of jobs added or lost within the past 12 months (please include part-time as fractions, i.e. ½, ¼.

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* 10. Current Business Environment:

Hiring

Stable but not hiring

Downsizing

If downsizing would you like us to contact you