Modify Your Business Profile    Information will be treated as confidential if shown in gray area.

This company is a (check all that apply). Manufacturer Food Processor Shared Service center Telemarketing center Exporter or Importer E-commerce High-tech service provider Ag commodity group Tourism Engineering/Research     Computer or Data Processing Service Provider (ie software development, web development, systems design, etc.)   If none of the above boxes have been marked, simply provide your name on Page 3, Section 14 of this survey. You need not complete the entire survey.   Business is Closed. Yes If yes, press exit (located above and to your right).

1. COMPANY BASICS  Company Name:    AKA/DBA:    Previous Name (if applicable):   ( same as physical address)  Physical Address:   Mailing Address:   City/State/Zip:     City/State/Zip:     Telephone:   Fax:      format (000) 000-0000    format (000) 000-0000 Web Site:   Email:   Year Established In Community:      Years In Business:       Beginning of Fiscal Year (month):   January February March April May June July August September October November December

2. VALUE ADDED Does your business add value to the product it sells?     Yes    No If yes, briefly describe what your company does to add value to your product(s).

3. MARKET BREAKDOWN State (ND) National (rest of US) TOTAL OF ALL FOUR CATEGORIES SHOULD EQUAL 100% If tourism-related, provide estimates as it relates to revenue source such as the home state or country of visiting tourists. Regional (SD, MT, MN) International (rest of world) Why do we ask this? The more sales you make outside the state, the more new money you are bringing into the state. Your response to this question (and a few others) will help us determine whether you are primary-sector (new wealth-generating) business. It could also make your company eligible for state incentives such as funding assistance and tax exemptions.

4. GROSS SALES What is the annual gross sales amount generated through your North Dakota facility? (Rounding off numbers is acceptable. If this is your first year in operation, please provide projections.)  $

5. VALUE STREAM As a supplier or sub-contractor, what percentage of your value-added product or service is produced for another company(ies) that ultimately sell it outside the state? (Examples: Producing components that another company uses to build a larger or more complicated piece of equipment. Developing software for a company that incorporates it into its final product and sells it nationally such as VARs.)  %   How much of the raw materials or services needed to produce your product is purchased from North Dakota Companies?   %   Companies located outside North Dakota? %     Please list the type of materials or services you cannot currently purchase in North Dakota.

6. LOCAL EMPLOYMENT By Function # Employed By Type # Employed If PT, how many hours?   Management   Full Time   30-40 hours per week   Technical   Part Time   20-30 hours per week   Sales/Marketing   Leased   10-20 hours per week   Clerical       Less than 10 hours per week   Production           Total   Total   Total Part-Time     Jobs added or lost in 2002:   Number of shifts per day:     Peak Employment Season:   Number of workdays per week: