Technical Assistance Business Grant Application
Please complete the form to register for the Business Infrastructure Grant.
Applicant Information
Name
First Name
Last Name
Date
-
Month
-
Day
Year
Date
Title*
*
Phone - Direct
Please enter a valid phone number.
Phone - Mobile
Please enter a valid phone number.
Email*
*
Business Information
Company Name*
*
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Year of Establishment*
*
Has the business been in operation for at least 1 year?*
*
Yes
No
EIN Number*
*
Please select if any of the following apply:*
*
Minority-owned
Women-owned
Black-owned
Veteran-owned
None of the Above
Where is your business located?*
*
Please Select
Academy Sherman Park
Euclid South CID
Grove CID
Industry Sector*
*
Please Select
Retail
Restaurant/Food Business
Hospitality
Manufacturing
Other
Other:*
*
Owner Information
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Email*
*
Funding Request
Amount of grant money being requested:*
*
W-9
*
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Explain how funds will be used to help Namethe business.*
*
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