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Request More Information

First step in application phase for admission to the Coastal Bend Innovation Center Incubator Program is to complete and submit the form below.

After the form is received someone will contact you to set up interview with Director.

* = Required Field

* Resident or Non-Resident
  Facility Name: Coastal Bend Business Innovation Center
* Company Name:
* Contact First Name:
* Contact Last Name:
  Is spouse active in the business? No    Yes
  Spouse's Name (if applicable):
* Address 1:
  Address 2:
* City:
* State:
* Zip Code:
* Phone Number:
  Fax Number:
* Email:
  Are you currently or do you have future plans to receive 75% of total revenues from outside Nueces or San Patricio counties? No    Yes
  List all persons with 20% or more ownership in the company:
  Form of Business: Sole Proprietorship
Incorporated
Partnership
LLC
Not incorporated at this time
Other
  Year Business Started:
* Company Type:
* Product & Service Description
(Paste Business Plan if available)
  How did you hear about us? Direct Mail
Newspaper
Radio
Billboard
Magazine
Internet Search Engines (Goolge™, etc.)
Referral
Name:
Company/Organization:
Other
* Desired Date of Admission:
 
All of the information provided in this inquiry is accurate and complete to the best of my knowledge and I am authorized to release this information. I certify that I have not submitted any confidential or proprietary information and acknowledge that no confidential relationship has been established with the Coastal Bend Business Innovation Center.
I agree
 
 
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