Initial Intake Form

Name

Date

Phone

E-mail

Role / Affiliation with the company

Title

Company Name

Address

City, State, Zip

Have you spoken to anyone in our office? if so, with whom?

Your role on behalf of the company

Notes

Company/Project name

Current Location

Existing in Monterrey?

Industry Description

NAICS

New employees projected by year

New employees projected by year 2

New employees projected by year 3

New employees projected by year 4

New employees projected by year 5-10

Job types 1:

Job Types2

Job Type3

Job Types4

Brief Project Criteria/Scope

Est. Total Private Investment $

Secured Financing

If no, please explain

Inmediate Parent Company

Ultimate Parent Company

Briefly describe type of assistance you are seeking

Select all that apply

Other

Primary function of this facility

Geographic region of interest

Projected Timeline

Initial site visit expected

Prelim decision date

Final decision date