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GOVERNOR'S INDUSTRY APPRECIATION LUNCHEON DISTINGUISHED BUSINESS NOMINATION FORM

Southern Nevada Companies: period from JAN. 1, 2001 to DEC. 31, 2001
Northern Nevada Companies: period from JULY 1, 2001 to JUNE 30, 2002

NEVADA LOCATION:

YEAR ESTABLISHED IN NEVADA:
COMPANY NAME:
Local Contact:
Title:
Physical Address:
City:
State:
Postal Code:
Mailing Address:
City:
State:
Postal Code:
Phone:
Fax:
E-mail:
Web Site Address:
Yes No:
If selected as honoree, can the above information
be printed in program booklet?
CORPORATE/HEADQUARTERS LOCATION:
Contact:
Title:
Mailing Address:
City:
Postal Code:
State:
Phone:
Fax:
E-mail:
Web Site Address:
PARENT COMPANY OR SUBSIDIARY OF:
If foreign, what country:
PRODUCT/SERVICE DESCRIPTION:
BUSINESS SECTOR:
MANUFACTURING DISTRIBUTION SERVICE
PERCENTAGE OF PURCHASES FROM NEVADA-BASED SUPPLIERS:
PRODUCT MARKETED:
LOCATION: PERCENTAGE:
Nevada
United States
International

NUMBER OF NEVADA EMPLOYEES:
BENEFITS (excluding mandatory):
DESCRIBE SAFETY RECORD:
TO MEET CORPORATE CITIZENSHIP REQUIREMENT, DESCRIBE IN-HOUSE PROGRAMS AND/OR COMMUNITY ACTIVITIES THE COMPANY AND/OR ITS EMPLOYEE GROUPS ARE INVOLVED IN:
OTHER FACTOR(S) TO BE CONSIDERED IN EVALUATING YOUR COMPANY:

COMPLETE THIS FORM AND SUBMIT BY: Southern Nevada Companies: return by March 1, 2002
Northern Nevada Companies: return by July 2, 2002
For further information or questions, contact Menyone Thomas at the Nevada Commission on Economic Development at [email protected] or phone (702) 486-2700 / toll-free (800) 336-1600.



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