Your Name:

Company Name:

Company Phone:

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1. Provide breakdown of any economic incentives currently received by the company:

2. Briefly describe company activity and include SIC or NAICS code:

3. Company structure (LLC, Partnership, Corporation) and name of parent company (if applicable):

4. Business address of company facilities:

5. Current employee count by state and hire date:

• Number of temporary, contract, leased and part time employees:
• Number of recent or planned employee hires–
  Year 1:
  Year 2:
  Year 3:
• Benefits and medical - percent paid by company for FT and PT employees:
• Average salary of new employees:
• Employee turnover/attrition rate:

6. Is the company currently in a federal or state income tax position?

Yes No

7. Is the company up to date on all state tax filings?

Yes No

8. Cost of recent (current year or future (12-36 months) capital investment/expansion:
Year 1:
Year 2:
Year 3:

9. Does the company offer training for new employees?

Yes No

10. Would you be interested in having a free analysis of your employees' benefit plans?

Yes No

• Is management considering any type of company acquisition in the future? Yes No