Headwaters Regional Development Commission - Bemidji, MN

Headwaters Regional Finance Corporation
Semi-Annual Job Report

If submitting form below through email, please fill out and hit the "Submit" button at the bottom of this form.

If you'd prefer to mail it to us, please click here to download a PDF to print out and mail. Instructions and address are at the bottom of this page.

Name of Company:
Address:
City:
State/Zip:
Contact Person:
Person filling out form:
Telephone Number:
Please complete the information below as of March 31, 2008.
Total Number of Employees: (persons for whom a W-2 or self-employment tax form will be prepared)
Number of Full-Time Employees: (40 hours/week or 2,080 hours/yr)
Number of Part-Time Employees:
Women Employees:
Minority Employees:
Handicapped Employees:
Your information is needed for loan administrative purposes only and will be kept confidential.
Signature:
Date:

Note If you will be submitting this form via the submit button rather than returning it via mail, you will need to enter your password on the signature line. You should have received your password in August. If you do not know your password, please call 218-444-4732. If you arereturning the document via mail, please print it, then sign on the signature line rather than using your password. Please return to the Headwaters Regional Finance Corporation using the Submit Button above or by mailing the completed form to: Headwaters Regional Finance Corporation PO Box 906 Bemidji, MN 56619-0906