Department of Commerce

Gender: Male Female
Race (optional): African American Asian Caucasian Hispanic Native American
Veteran Status (optional): Service-Disabled Veteran Veteran Non-Veteran Other

1. Referral Information: How did you hear about the Montana Technology Innovation Partnership Program?
Chamber of Commerce Email Internet Magazine/Media Other Past Research Grant Winner Professional Technical Assistance Center Small Business Development Center University Word of Mouth

2. Organizational Size and Structure:
Have you established and formed a company? Yes No N/A
What date was it formed?
Total number of employees: Full Time Part Time
Does your company have sales? Yes No
Structure: Corporation Limited Liability Company Non-Profit Corporation Not in Business at this time Partnership Sole Proprietorship Sub S Corporation

3. Business Type: Certified SDB or SBA 8(a) Small Disadvantaged Small Minority-Owned Small Other Small Woman-Owned Small

4. Industry Type: Aerospace Agriculture Bioscience Energy Forestry Information Technology Other

5. In non-confidential terms, briefly describe the nature of your core technology.

6. Describe one end user for your product or service.

7. How would that end user benefit by having it?

8. Do you have specific questions or concerns to be addressed?