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2. First Name*
3. Last Name*
5. Company Name*
6. Job Title*
8. Work Email*
9. Work Phone*
11. Company Address*

    Street Address

12. Address Line 2
14. City*
15. State*
16. Zip Code*
20. Select the Primary Economic
22. Activity of the Business*
    -- Select One --Agricultural BusinessesArt and Creative BusinessesConstruction BusinessesE-commerce BusinessesEducation and Training BusinessesEnergy and Utilities BusinessesEntertainment and Media BusinessesEnvironmental and Green BusinessesFinance and Banking BusinessesFood and Beverage BusinessesHealthcare BusinessesHospitality BusinessesManufacturing BusinessesMining and Extractive BusinessesPersonal Care and Wellness BusinessesProfessional and Consulting ServicesReal Estate BusinessesRetail BusinessesService BusinessesSocial and Community ServicesTechnology BusinessesTransportation BusinessesWholesale BusinessesOther
24. Number of Full-Time Employees
26. Hiring State*
    -- Select One --DownsizingHiringNeutral
28. Size of Facility (Square Feet)*
30. Is there potential for Expansion / Contraction?*

    1. Expansion Opportunity
    2. Contraction Risk
32. Challenge Areas*

    1. Current Location
    2. Data - Internet Needed
    3. Employee Training
    4. Government Policy - Tax
    5. Infrastructure
    6. Internet - Data Connectivity Issues
    7. Location - Neighborhood
    8. Recruitment
    9. Retention
    10. Taxes - Tariff
    11. Transportation
    12. Utility Related
    13. Other

    Please select at least one option.

34. Please Provide Additional Information Regarding Challenge Area(s)
Leave This Blank:


36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit

* indicates a required field