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| *Company Name: |
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| Incorporation Number: |
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| Incorporation Date: |
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| *Contact Person: |
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| *E-mail: |
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| Mailing Address: |
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| City: |
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| Postal Code: |
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| Phone: |
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| Fax: |
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| Website: |
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| Principals/Owners: |
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| Auditing Firm: |
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| Company Bank: |
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| Reference: |
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| Technology Category: |
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What industry are you in?
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| If Other, please specify: |
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| Business Origin, History and Concept: |
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| Capitalization: |
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| Operating Budget: |
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| Sales Revenue: |
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| Number of Employees: |
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What will be the business of the company in the coming year? |
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What are the company's research activities? |
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What hazardous materials will be used? How will they be stored? |
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What chemicals (gases, liquids and solids) and biological (animal and human tissue, microorganisms) wastes will be produced? How will they be stored? |
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Are radioactive or biological materials or human subjects to be used (or is their use planned)? |
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What safety/procedures training to employees receive? |
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What are your written procedures for hazardous materials usage, storage, disposal and emergency response? |
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| Approximate Wet Lab area required (ft2, m2): |
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| Approximate Office area required (ft2, m2): |
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| Approximate Other area required (ft2, m2): |
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| Services: |
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| Approximate Occupancy Date: |
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| Approximate Occupancy Duration: |
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Describe if the business or its Principals have any current/prior relationship with the University of Alberta or its Faculty, Staff, Students and if relocating from another University of Alberta location.
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