CleanTech Manufacturing Center Request For Interest Response Form

I. Company Information

Company Name
Company Address
City/State/Zip/Country
Website
Contact Person: Name
Contact Person: Telephone
Contact Person: Email Address
Contact Person: Mailing Address
Total Number of employees

II. Company Products

Please check all that apply regarding primary sustainable company products and/or processes:
Clean energy generation
Sustainable building materials and/or furnishings
Clean water technology
Reduced vehicle emissions technology
Manufactured products using Recycled / Organic Material
Other (Please describe upto 50 letters)

In the space below please provide a description of the main company product(s): [limit 255 characters]

III. The following questions pertains to your company needs for the CleanTech Manufacturing Center

Space Requirement (s.f.)
Proposed Product(s) or Business Line
Desired/Projected Occupancy Date:
Potential Expansion Requirement (s.f.) (future growth)
Prefer to
Projected number of employees at the site

Please estimate the percentage breakdown of employee types at the site:

The sum of the numbers entered must equal 100.

High-tech skilled	%
Engineering & Desing	%
Assembly line manufacturing	%
Clerical	%
Administrative	%
Entry level	%
Other (describe)	%
Total	%

IV. Cover letter and additional Comments

Please use the space below to provide a cover letter describing your company's relationship to sustainability, renewable resources, etc. [limit 600 characters]

Additional material (optional) should be submitted in PDF attachment upto 1MB in file size.

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