SNAP POS Grant Application

Grocery Store Point of Sale Expansion Grant
The Grocery Store Point of Sale Expansion Grant provides reimbursement to SNAP retailers for the purchase of wireless point-of-sale (POS) machine to process electronic benefits transactions (EBT) made by Minnesotans using their Supplemental Nutrition Assistance Program (SNAP) benefit card (pin transactions) both curbside pickup and/or customer delivery.

SNAP retailers may receive up to $500 for money spent purchasing and integrating the remote POS system. Retailers can apply for this reimbursement grant through December 30, 2020 at 4:00pm. Completed applications may be submitted online, emailed to kfrederick@mngrocers.com or mailed to: Minnesota Grocers Association, 1360 Energy Park Drive, Suite 110, St. Paul, MN 55108. Applications must be complete to receive payment.
Contact*

First NameLast Name
Store Name*
Parent Company if Applicable
E-mail*
Phone Number*

Phone Number
Physical Address*

Street Address

Street Address Line 2

CityState

Zip Code
Federal Tax ID#*
State Tax ID#*
FNS Number*
DUNS Number
Company Website
Who is your third party processor?*
How long have you accepted SNAP?*
What is your estimated activation date to begin processing wireless curbside/delivery transactions.*

MonthDayYear
Are you currently or working to accept SNAP online transactions?*

YesNo
Describe your store*

Traditional SupermarketLimited Assortment StoreSupercenterDollar StoreDrug StoreWholesale ClubConvenience StoreSmall Market (Specialty)

Summary of Receipts. Please list all eligible purchases below, one receipt/invoice per line. Attached additional spreadsheets if necessary.*

Upload Receipts*

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The following items must be submitted with your application to be considered complete:
- Completed application form with your signature.
- Copy of receipts/paid invoices/proof of purchase for the items you are submitting for reimbursement. We recommend only including eligible items on the receipt.
- IRS Form W-9, signed and dated (available at https://www.irs.gov/pub/irs-pdf/fw9.pdf).
By signing here, I acknowledge that I have read and agree to the Privacy Notice, I hereby attest that the information I am submitting is true, complete, and accurate.
Signature

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Minnesota Grocers Association 1360 Energy Park Drive, Suite 110, St. Paul, MN 55108 p:651-228-0973 f:651-228-1949 www.mngrocers.com
This application serves as a request for reimbursement from funds that originated with the federal CARES Act and have been designated by the State of Minnesots to support SNAP distribution efforts in Minnesota in response to the COVID-19 pandemic. This grant application is directed by the Minnesota Grocers Association (MGA) in partnership with the Minnesota Department of Human Services.
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