Principal Business Owner(s) Representing 10% or Greater Ownership:
Please provide contact name, company, and phone number of two trade references:
I authorize that all information provided on this form, including any and all personal and financial data, will be used to evaluate admission into the Louisiana Business & Technology Center for the Incubator Program. I authorize its verification through the 3rd party listed within the application and the information may be shared with Louisiana Business & Technology Center and the listed 3rd Party. This data will be securely retained for five years. To learn more about privacy at LSU, please see the LSU Privacy Statement.