Business & Industry Asset Survey

First Name: Last Name: Email: Please list full name of your business or organization:   Who is a contact person for your organization?:   Address:   City:   State:   ZIP Code:   Telephone:   Fax:   Email Address:   Website:   Please give a brief description of your business or organization, including products or services offered.:   Mission Statement:   Number of Employees:   Choose 1   No employees, only the owner(s). 1 to 4 5 to 9 10 to 19 20 to 49 50 to 99 100 or more employees Number of years in Plumas County:   Choose 1   Less than 1 year. 1-5 years 6-10 Years More than 10 years. To describe your target audience, please mark all that apply:   Select all that apply   Customers that live in the area Tourists Online customers 0-17 years old 18-30 years old 31-50 years old 51-65 years old Over 65 years old Which of the following industry sectors best describes your business or organziation?:   Choose 1   Agriculture & Mining Construction Manufacturing Transportation and Public Works Wholesale trade Retail trade Finance, insurance, & real estate Services Government & public adminstration Tourism Education Health care & social assistance Other Non-Profit Organization Would your organization be interested in seeking partnerships for community grants?:   Yes No If you are interested in seeking grant partnerships, please mark all potential in-kind contributions your organization would be able and willing to provide.:   Choose 1   Office or work space Employee time Access to volunteers Printing/office supplies Administrative support Marketing/Public Relations Support Services Grant and report writing services Event planning services Event facilities Other services Please describe your organization's goals for the next 3-5 years and how these might impact community partnerships.:   Security Code:    (Please enter the letters you see in the image above)