Certified Site Intake Form Thank you for your interest in participating in the Arizona Certified Sites (Buildings) Program. The following intake form is to be used a as a "pre-screening" process to ensure your property meets minimum qualifications to continue forward in the certification process. Please answer the follow questions to the best of your ability. Please email your questions to firstname.lastname@example.org. The location of your site will be shown on the map once you enter an address. You can adjust the location by dragging the marker to the correct location. Place Marker | Reset Map | Toggle Size Site Name Site Address City, State, Zip Code Does the site contain 5 or more developable acres? YesNo Does the site have a willing seller or lessor with a set asking price? YesNo Does the site have proven alignment with the local city, town or county? YesNo Does the building have at least 3 of the following criteria: Road Access, Electric, Natural Gas, Water, Sewer/Septic and/or Telecommunications? YesNo Are there any environmental issues at the site? YesNo If any environmental issues exist, are you in the process of remediating them with the organizations? YesNoN/A Is the site appropriately zoned for industrial/office (not retail) or is there an expedited rezoning plan in place? YesNo Community / Economic Development Organization Contact Information Name Organization Title Address City, State, Zip Code Phone Number Email Address Checking this box indicates that I am authorized to submit this information on behalf of the property owner(s) and that all information provided is correct to the best of my knowledge. Property Owner or Authorized Representative Contact Information Name Company / Organization Title Address City, State, Zip Code Phone Number Email Address Checking this box indicates that I am authorized to submit this information on behalf of the property owner(s) and that all information provided is correct to the best of my knowledge.