Get documents about "VEGI PreApplication Forms 6 06 2012
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A B C D
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FORM A - PRELIMINARY APPLICATION APPLICANT INFORMATION
Read the VEGI Preliminary Application instructions before filling in this form
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Official Name of Business
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Common Name (i.e. dba, if
4 different from Line 3)
5 Mailing Address
6 a. City/Town b. State/ Province
7 a. Postal Code b. Country
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a. Telephone Number b. Fax Number
North American Industrial
Classification System code
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(6 Digits)
Form of Corporation
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11 Fiscal Year End
State of Incorporation
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Type of Company/Project
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14 If Vermont Division, Location of parent company
Physical Address/ Location of
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proposed Project
16 Application Contact Person
17 a. First Name b. Last Name
18 Title
Address
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20 a. City/Town b. State/ Province
21 a. Postal Code b. Country
Telephone Number and extension
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23 Mobile Number
24 Fax Number
25 Email Address
Version 2.20 08 Form A - Applicant Information Page 1
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Description of applicant's primary
business activity:
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Description of activity to be
incented:
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Eligible for Enhanced VEGI for
Environmental Technology
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Companies?
Activity Commencement Date:
29 Month, Day, Year
Date Preliminary Application
30 Submitted: Month, Day, Year
31 Version: 6.6.2012
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Version 2.20 08 Form A - Applicant Information Page 2
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Version 2.20 08 Form A - Applicant Information Page 3
E F G H I J K L
1 Column1
2 C
3 LLC
4 LLP
5 Other
6 Partnership
7 S
8 Sole Proprietor
9 Not for Profit
10 Non Profit
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13 Column1
14 Expansion of Vermont Company
15 Expansion of Multi-state Division Already in Vermont
16 Moving a Multi-state Division to Vermont
17 Establishing a new Division of a Multi-state Company in Vermont
18 Establishing a Completely New Business
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Version 2.20 08 Form A - Applicant Information Page 4
E F G H I J K L
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29 January 1 2010
30 February 2 2011
31 March 3 2012
32 April 4 2013
33 May 5 2014
34 June 6 2015
35 July 7
36 August 8
37 September 9
38 October 10
39 November 11
40 December 12
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Version 2.20 08 Form A - Applicant Information Page 5
E F G H I J K L
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Version 2.20 08 Form A - Applicant Information Page 6
A B C D E F G H I J K L M N
1 FORM B - PRELIMINARY APPLICATION 0 Project Data Data in this beige section is
Read the VEGI Pre-Application Instructions before filling in this form
2 for Administrative use only
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Data Part 1: NUMBER OF EMPLOYEES, ANNUALIZED PAYROLL, AND CAPITAL INVESTMENTS FOR YEAR 1
THROUGH ACTIVITY COMMENCEMENT DATE (ACD): January 1, 0 up to 0 0 0
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5 NUMBER OF EMPLOYEES: ANNUALIZED PAYROLL: CAPITAL INVESTMENTS THRU ACD:
6 TOTAL EMPLOYEES: 0 TOTAL PAYROLL: $0 TOTAL CAPITAL INVESTMENTS $0
7 OTHER SUBTOTAL: 0 OTHER SUBTOTAL: $0 a. Machinery and equipment acquired
8 a. Owners a. Owners b. Machinery and equipment new
9 b. Part-time/Seasonal b. Part-time/Seasonal c. Machinery and equipment used
10 FULL-TIME SUBTOTAL: 0 FULL-TIME SUBTOTAL: $0 d. Plant and facility acquired
11 c. Non-Qualifying c. Non-Qualifying e. Plant and facility built new
12 d. Qualifying d. Qualifying f. Plant and facility renovations
13 g. Land
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Data Part 2: EMPLOYMENT, PAYROLL, CAPITAL INVESTMENT: HISTORIC AND PROJECTED
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2. EMPLOYMENT:
16 Year -3 Year -2 Year -1 Year 0 Year 1 Year 2 Year 3 Year 4 Year 5
17 -4 -3 -2 -1 0 1 2 3 4 TOTALS TOTALS
18 TOTAL EMPLOYEES 0 0 0 0 0 0 0 0 0 0
19 TOTAL ADDED EMPLOYEES: 0 0 0 0 0 0
21 a. Owners 0
22 b. Part-time/Seasonal 0
24 c. Non-Qualifying 0
26 d. Existing Qualifying
27 e. New Qualifying 0
3. PAYROLL:
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29 Year -3 Year -2 Year -1 Year 0 Year 1 Year 2 Year 3 Year 4 Year 5
30 -4 -3 -2 -1 0 1 2 3 4
31 TOTAL PAYROLL: $0 $0 $0 $0 $0 $0 $0 $0 $0 $0
33 a. Owners $0
34 b. Part-time/Seasonal $0
36 c. Non-Qualifying $0
38 d. Existing Qualifying $0
39 e. New Qualifying Payroll - Cummulative Increase (Cells will auto-fill) $0 $0 $0 $0 $0 $0
40 f. New Qualifying Payroll - Annual Only $0
41 g. Average Annual Percent Increase:
42 h. Benefits Ratio:
4. CAPITAL INVESTMENTS:
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44 Year 0 Year 1 Year 2 Year 3 Year 4 Year 5
45 -1 0 1 2 3 4
46 TOTAL CAPITAL INVESTMENTS: $0 $0 $0 $0 $0 $0 0
47 CAPITAL INVESTMENT TARGETS $0 $0 $0 $0 $0 0
48 SUBTOTAL MACHINERY AND EQUIPMENT: $0 $0 $0 $0 $0 $0 0
49 a. Machinery and Equipment - Acquired 0
50 b. Machinery and Equipment - Purchased New 0
51 c. Percentage Purchased from within VT
52 d. Machinery and Equipment - Purchased Used 0
53 e. Percentage Purchased from within VT
54 SUBTOTAL PLANT AND FACILITIES: $0 $0 $0 $0 $0 $0 0
55 f. Plant and Facilities - Acquired 0
56 g. Plant and Facilities - Built New 0
57 h. Percentage Purchased from within VT
58 i. Plant and Facilities - Renovations 0
59 j Percentage Purchased from within VT
60 k. Land 0
5. CAPITAL INVESTMENTS: TYPE OF FACILITY
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62 Year 1 Year 2 Year 3 Year 4 Year 5
63 0 1 2 3 4
64 TOTAL PLANT AND FACILITY INVESTMENT: $0 $0 $0 $0 $0 0
65 PERCENTAGE BY TYPE OF USE: 0% 0% 0% 0% 0%
66 a. Industrial:
67 b. Commercial/Non-Office:
68 c. Office:
69 d. Warehouse/shipping-receiving:
70 e. Other:
Data Part 3: BREAKDOWN OF QUALIFYING JOB CREATION
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72 Year 1 Year 2 Year 3 Year 4 Year 5
JOB CATEGORY 0 1 2 3 4
73 AVG ANNUAL SALARY/ WAGE
74 0
75 0
76 0
77 0
78 0
79 0
80 0
81 0 0
82 TOTALS 0 0 0 0 0 0
ESTIMATED HIRING BY CALENDAR QUARTER
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84 $0
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86 Year 1 Year 2 Year 3 Year 4 Year 5
87 Data in this beige section is 0 1 2 3 4
88 for Administrative use only $0 $0 $0 $0 $0 $0
89 $0 $0 $0 $0 $0 $0
90 $0 $0 $0 $0 $0 $0
91 $0 $0 $0 $0 $0 $0
92 $0 $0 $0 $0 $0 $0
93 $0 $0 $0 $0 $0 $0
94 $0 $0 $0 $0 $0 $0
95 $0 $0 $0 $0 $0 $0
96 TOTALS $0 $0 $0 $0 $0 $0 $0
97 VERSION 6.6.2012 #DIV/0! $0
98 $0
Version 2 20 08 Form B - Project Data Page 7
