Please print out the form below. Mail or Fax it to:
Titusville Redevelopment Authority
Attention: Mike Allyn
PO Box 425
Titusville PA 16354

As a prerequisite to a formal application for industrial or commercial space, from the Titusville Redevelopment Authority, this form must be completed to the best of the applicant's ability and submitted by the business. Once the Authority has the opportunity to determine the initial suitability of the proposed business in the site, an invitation to submit a formal application will be extended in writing.

Date:______________________

Company Name:_____________________________________

Current Address:_____________________________________

___________________________________________________

Phone Number:__________________

Fax:__________________

E-mail:_____________

Contact Name:_______________________________________

Contact's Title:_______________________________________

Square Footage:    mfg.___________warehouse__________commercial_________

Building of interest:__________________________________

We are an: ___ Established business, ___ a Start-up

Current number of Employees:_____

Number of Employees Projected at this location______

Type of Business:_____________________________________

Date initial occupancy is:   Desired_________________ Required_________________

The following information will assist the Authority in selecting the businesses and industries that show potential for providing the most overall benefit to the Community. (Items preceded by a * must be completed)

Business Plan Completed and Available
* Attach a brief summary of what you intend to make sell, or do, on the property.

Quality Jobs:

1. *Number of jobs to be created _______________or,   retained______________________
2. Average hourly rate_______X number of employees_______X hours per  wk=__________
3. Benefits: Health_________ Retirement_________ Vacation_______ Profit share_________
4. Long term employment prospects (good, average, uncertain)_________________________
5. The company is committed to a policy of promoting continuous education and  training: _____ for all employees _____ selected employees _____no employees
6. Advancement potential (good, average, limited)__________diverse levels of employment at this location (production, supervisory, management-yes,  no)_________________________
7. Access to capital: *How do you intend to finance your project? (indicate below, the % of the proposed project funding anticipated in the following  categories)
   1.    Conventional financing__________(committed)_______ If so, what bank?______
   2.    Owner Financing_____________________________
   3.    Subsided Loans through TRA or another Government entity_______(committed)____          if so  what program?______________________________________________ ____
   4.    Total Project Costs: (approximate, if unknown at his time) _____________________                 

Who are you?

1. Do you have other operational locations______________if so, give locations_____________

2. How long has your company been doing the type of work you are proposing to do  here?              ___________________________________________________

3. Are you a division of a larger corporation?______________ Who?____________________

4. If this is a new start-up, do you have experience in this business?_______________________

5. *Will your establishment here cause jobs to be lost in some other area?__________________

6. Have you ever closed an operation at another location?________if so, where and when?              ___________________________________________________

7. If not a local company, do you have any local business references?  Please list:                               ___________________________________________________

8. *Are there any environmental concerns associated with your operations?  If so, what are they?
____________________________________________________

9.    Trucks per day that I expect will deliver __________ and ship _______ at my operation.

RR car loads per month will  _______deliver and  ______ ship per month.

10.     How did you learn about this site? __________________________________________________

To the best of my knowledge, the information provided above is true and correct.

Signed______________________________________________

Title________________________________________________

Any questions about this form, the facilitates, or potential financial assistance should be directed to Mike Allyn at 814-827-3668, fax 814-827-2696, or email  info@tcda.org.