VIRGINIA DOD RURAL GROWTH PROGRAM Application

Company Name

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Website

FEIN(Required)

DUNS #(Required)

Number of Employees(Required)

Number of Employees in VA(Required)

What % of sales are to defense agencies?(Required)

Are you currently pursuing additional defense business?

Yes

Is your company a veteran and/or service disabled veteran owned business?

Yes

Is expanding defense business part of your business strategy?

Yes

Unknown

Would growth in defense business impact your employment?

Yes

Unknown

If you answered 'Yes' to the previous question, enter the number of potential jobs?

Please briefly describe your company's products and/or services.

Specifically, what product/service opportunities are there for you to increase your defense sales?

Briefly describe where you are in developing new products or services to grow your defense business?

PRIMARY POINT OF CONTACT

Name

First Last

Title

Phone

What services are you interested in?

Terms and Conditions

All program benefits are delivered as services. Company agrees to participate in the CoreValue® Assessment or Competitiveness Review at no cash cost to the client. Upon completion of assessment, a company improvement plan will be delivered. At company's request, a proposal for service will be prepared for consideration. Company cost share for services will equal 20% cash (non-refundable) upon acceptance. Program will bear remainder.

Auth

I am authorized to execute this application on behalf of my company.

Name

Title

Date

Signature

Please enter your initials here to act as your signature.

All information will be kept CONFIDENTIAL and only used for program selection. Data will only be shared in aggregate form with no identifiable information provided.

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