Amarillo Enterprise Challenge Application

Amarillo EnterPrize Challenge Application

West Texas A&M University Enterprise Center banner

Company Name:^*

Desc. of Product/Service:^*

Contact Name:^*
First:
Last:

Address 1:^*

Address 2:

City:^*

State:^*

Zip Code:^*

Phone Number: ^*

Fax Number:

Email: ^*

Does the company currently or have future plans to receive 75%
of total revenues from outside Potter and Randall Counties?

No
Yes

List all persons with 20% or more ownership in the company (Please list your spouse if he/she is active in the business):

Full Name	Address	City	State	Zip Code	Phone	Email

Form of Business:

Sole Proprietorship
Incorporated
Partnership
LLC
Not incorporated at this time
Other

Year Business Started:

Type of Business: ^*

Biotechnology
Manufacturing
Information Technology
Sales & Distribution
Business Services
Other

How did you year about us?

Direct Mail
TV
Newspaper
Radio
Billboard
Magazine
Internet Search Engines (Google™, etc.)
Referral
Other

All of the information provided in this inquiry is accurate and complete to the best of my knowledge and I am authorized to release this information. I certify that I have not submitted any confidential or proprietary information and acknowledge that no confidential relationship has been established with the WTAMU Enterprise Center. No
Yes