Business Application Form

Business Information
Street Address

Street Address

CityState / Province

Postal / Zip Code
Mailing Address

Street Address

CityState / Province

Postal / Zip Code
By signing I acknowledge that all the information on this form is true and correct to the best of my knowledge. I understand that service is not guaranteed and is dependent on funding and eligible repairs listed in the funder guidelines.
Date

MonthDayYear
Date
Business Owners Name

First NameLast Name
Business Owners Signature

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Business classification (Sole Proprietorship, S or C Corporation, Partnerships, limited partnerships, etc.)
**Ensure that your business is classified as small under the RCW 39.26.010: Definitions. (Section 22)** IF THE BUSINESS FAILS TO MEET THESE CRITIAS THEN THE FORM WILL BE DENIED.

**Copy of income required** (Examples are Income Statements, Tax returns, or Documentation of Return filed with the Department of Revenue for the past three years.)
Income Documents

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**Proof of 50 or less employees required** (Examples are small business health insurance documents, Payroll Documentation, etc.)
Proof of Employee Count

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Should be Empty:

Business Application