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2. Property Address
   Please enter the address of the property where the incentives will be applied.
3. Is this a business relocation (new business to Frederick) or a business expansion (business currently within Frederick)?*

   1. Relocation
   2. Expansion
5. Is there an existing business at this location?*

   1. Yes
   2. No
6. Anticipated date of new business occupying the location*
   Please enter the date the business will take occupancy at the property address. If this is a business expansion, please estimate the date the expansion will be completed.
8. Business Owner Name/s*
   Please provide the names of the business owners. If the owner is an entity, please list personal representatives.
9. Business Owner Email*
   Please provide email address to contact the business owner.
11. Business Owner Phone Number*
    Please provide a phone number for the business owner.
12. Business Consultant Name
    Please provide a lead consultant name.
14. Business Consultant Email
    Please provide the consultant's email address.
15. Business Consultant Phone Number
    Please provide the consultant's phone number.
17. Preferred Contact
    Should a Business Owner and Business Contact both be listed, please indicate which individual is the preferred contact.
19. Proposed Project Description*
    Please provide a description of the business moving to/expanding within Frederick. What type of business is it and what business activities will occur on the site? Are you proposing to build a new building? What is the expected timeframe for this to occur?
21. Number of Employees*
    Please provide the number of employees employed by this business when it is operational in Frederick.
22. Average Salary*
    Please provide the average salary of the company. This should consider the total number of employees and their associated salaries and benefits. Total those costs and then divide the total by the number of employees.
24. Healthcare costs*
    Please indicate the percent of employee healthcare costs paid by the company for those employees that are eligible for the benefit and choose to take it.
25. Please provide the total capital investment for the site.*
    Please indicate the cost to develop the site for the new business or business expansion. This value should NOT include the cost of the land.
27. Does the business generate sales tax?*

    1. Yes
    2. No
28. If the business generates sales tax, please provide the gross annual taxable sales.
30. Additional Information*

    1. Agree
    2. Disagree

    Please indicate by selecting a button, that by completing this form, you are submitting an application to receive business incentives. Additional information may be needed to determine eligibility.
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32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit

* indicates a required field