Indicates required field Email Address Name of person completing this application: What is your role within this company? Please list your contact phone numbers: What is the name of the company? What is the physical address of this company's location for which you are applying? What is the mailing address of this company's location for which you are applying? if same, type "SAME" on the line. What is your business entity type? - Select -For Profit CorporationLimited Liability CorporationLimited Liability PartnershipLimited PartnershipGeneral Partnership How many full time employees in total does this company employ? Full time employees are employees who work at least 30 hours per week and are compensated for working at least 30 hours per week What is the number of full time employees hired during prior 18 month period from date of application? If your company has not hired 10 or more employees new employees in the preceding 18 months, please do not continue this application. Your company does not qualify according to the legislation which governs this grant. Please upload a spreadsheet or document listing full time positions created within the past 18 months. In addition, list the hire date and hourly wage rate for each position One file only.100 MB limit.Allowed types: doc, docx, odt, odp, xls, xlsx, ods. What is the company's website? Please provide the company's Federal Tax ID Number. What is the company's state of formation? What industry or market segment best describes your niche? e.g. logistics, healthcare, retail, restaurant, service business, general business, consulting, etc What is the service/product produced? What makes your company's product or production processes innovative? Please list the applicant's officers and directors. Is the company registered to conduct business in Tennessee? Yes No Please upload a certificate of Authorization/Good Standing if the company has operated for one full year or more. For companies that have been in operation in Tennessee for less than one year upload either a Certificate of Existence. Please visit Tennessee Secretary of State Certificate of Existence page for more information One file only.100 MB limit.Allowed types: pdf, doc, docx, odt, ods, xls, xlsx. Do you have a certificate available now? I am uploading a certificate now I will submit a certificate later Have all property taxes been paid? Yes No Have all business taxes been paid? Yes No Does the company have a valid/unexpired license in the City of Chattanooga/Hamilton County? Yes No Statements Section To the best of my knowledge and belief, the information contained in this Chattanooga Application for Incentives is true and correct, as evidenced by my confirmation below. I further certify that the business entity is in good standing under the laws of jurisdiction(s) in which the entity organized or authorized to conduct business and that no delinquent taxes are owed to any taxing entity.Furthermore, I understand the incentive will reimburse a Qualified Small Business for all or part of its documented expenditures related to the acquisition, preparation or occupancy of office space and other facilities with the City, costs of moving to or relocating within or to the City, costs associated with initial or ongoing training of employees located at the Qualified Project Site, or other such costs or expenses.A copy of your responses will be emailed to the address you provided. I confirm the statements shown above.