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2. Economic Development Incentive Zone Application
4. Name*

   Primary Point of Contact

5. Email Address*
7. Address
9. City
10. State
11. Zip Code
13. Phone Number*
14. Fax Number
18. Business and Project Information
20. Economic Development Incentive Zone*
    -- Select One --Defense Production ZoneRalph Bunche Revitalization ZoneTechnology Zone

    Defense Production Zone, Ralph Bunche Revitalization Zone, Technology Zone

21. Business Name*
23. Company/Tax ID *
24. Business is*

    1. New

    1. Existing / Expanding

    1. Existing / Relocating
26. Project Location*

    Please include the name of the property or tax parcel, or building

30. Job Creation and Capital Investment
32. Please indicate the type and number of new full-time employees that will be created by this project:*

    Example: 

    5 software developers

    10 machinist 

    5 system administrators

    7 computer component assemblers

34. Please provide the approximate capital investment being made in business personal property taxes: *

    Be as detailed as possible:

    Example: 

    $250,000 in new computer equipment and network infrastructure

    $250,000 in new metal machining equipment

    $50,000 in new welding equipment

36. Please provide the approximate capital investment in real property:*

    Be as detailed as possible: 

    Example: 

    $10,000,000 in new shell building

    $50,000 in new fire sprinkler system

    $250,000 in secure office spaces

    $500,000 in new lab space  

40. County Interest
42. Briefly describe your interest in King George County, and how your business contributes to the goals of the Zone, and the County's economic strategic plan (available online.)*
44. Briefly describe how your business aligns with the goals of the county's comprehensive plan (available online.)*
46. How did you find out about the King George County Economic Development Incentive Zones:*

    1. Word of mouth
    2. Newsletter
    3. Social Media
    4. Website
    5. Print

    Check all that apply

50. Required Documents
52. File Upload*

    Please upload any relevant documents. 

    Example: 

    Business plan: financial health, growth plans, business history

    Project plan (if available) 

    Certificate of Incorporation 

    Information on business governance 

56. Signature Agreement
58. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
60. Electronic Signature
Leave This Blank:


62. 1. Receive an email copy of this form.
63. Email address

    This field is not part of the form submission.

64. Submit Submit and Print

* indicates a required field