HomeMy WebLinkAboutGrant ApplicationTHE MICRO -ENTERPRISE ASSISTANCE
GRANT PROGRAM
GRANT APPLICATION
Date: Grant Request Amount: $
Name of Grantee: Social Security Number: .c-1‘
Home Address: 1 S 7
City/State/Zip Code:
-3(c -e—
Home Phone: 3 --"C'1-"C Cellular Phone:lit--(..c.-.) Pager:
E-Mail Address(es):
• .' 4
, .0e. • '
Drivers License #:
U.S. Citizen Yes
Type Of Business:
Collateral:
No
," • -- 141-72. .re't
Yes
Name of Bank:
No If yes type:
Checking Savings
Contact Name: Contact Phone #:
Address: City State
Zip
REFERENCES: (Family members may not be used as references; References must be local Florida
Residents)
Name
Address
. 4
47!'
Telephone
City „.3.
State
Zip
Name
Address
City
Sta.'
Zip e"
Telephone
Name
Address
City
State
Zip
Telephone
12
THE MICRO -ENTERPRISE ASSISTANCE
GRANT PROGRAM
SOURCES AND USES OF FUNDS FORM
OWNER'S EQUITY
Existing
Cash in Bank
IRA's
CD's
Other (stocks, bonds, etc.)
New:
MICRO -ENTERPRISE GRANT
New:
USES OF FUNDS
Improvements
Inventory
Equipment
Fixtures
Remodeling
Working Capital
$
$
$
$
Total $
Total $
Total
$ ,,•'C f (`O O
$
$