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CITY OF MOUNDS VIEW <br />INDUSTRIAL REVENUE BOND REQUEST FORM <br />1. Company Name <br />Address <br />State of Incorporat <br />Contact Person <br />2, Type of Busi <br />Products or Services <br />3. Site Loca <br />4. Nature of Projec <br />Tel. No. <br />5. Current and Projected (5 years) Employment <br />Current Projected <br />Amount of Anticipated Payroll Increase <br />6. Present Gross Earning or Sales of Company. <br />7. Projected Gross Earning or Sales of within: <br />Two Years Within 5 Years <br />8. Size of Proposed Structure or Expansion Sq. Ft. <br />9. Estimated Project Cost: <br />Land <br />Buildings <br />Equipment <br />Other <br />Special Utility Needs <br />(water volume, waste <br />treatment, etc.) <br />TOTAL <br />Estimated Size of the issue. <br />If the issue is less than <br />estimated project cost, <br />indicate balance of <br />anticipated projuct funding: <br />10. Estimated additional tax revenue from project <br />11. Fiscal Consultant/Underwriter./Purchaser <br />Address <br />Contact Person Tel. No. <br />12. Legal Counse <br />Address <br />Contact Person <br />Tel. No. <br />