Heart Tank Application Form
Full Name
*
First Name
Last Name
Phone Number
*
E-mail
*
example@example.com
Business Name
*
Business Type
*
Please Select
Sole Proprietorship
Partnership
LLC
Corporation
Cooperative
Amount Requested (up to $5,000)
*
Date Completed SBDC Program:
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-
Month
-
Day
Year
Date
Location of Business
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Business Plan Upload
*
Browse Files
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of
Itemized List of how the funds will be used:
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Why this grant? In 300 words or less, explain why this grant is important to your business journey.
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0/300
Economic Impact Statement. In 300 words or less, explain what your vision is for the Heart of Wisconsin Community.
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0/300
I understand that submitting this application does not guarantee funding and that the Heart Tank Committee has full discretion in the selection process and final funding decisions.
*
I agree
I hereby grant the Heart Tank Committee, and its representatives, the irrevocable and unrestricted right and permission to use my name, likeness, image, and the name and likeness of my business, in any and all of their promotional and marketing materials, including but not limited to photographs, videos, and testimonials. This includes use on websites, social media platforms, and in print publications, without any compensation or prior approval. I release the Heart Tank Committee from any and all claims and demands arising out of or in connection with the use of such materials.
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I agree
Signature
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