HomeMy WebLinkAboutMANDOS_APP_W9.pdfSMALL BUSINESS ASSISTANCE GRANT APPLICATION
Complete the fillable application in its entirety. Print the completed application, sign and date and email, along with a copy of your W-9, to: OED2@auburnwa.gov.
Applications can also be mailed to the following: City of Auburn Attn: Office of Economic Development 25 W Main Auburn, WA 98001
TO BE COMPLETED BY APPLICANT
Name of Business Owner(s): ½ t, c... k � r-\ C,l) ·x:
Business Address: __ (_o_· _1..,, __ 6_" _...._r{\__,_P\_,_1 _� __ -s_---,_l __ A ..... v_'v_'-1 <"' W I\
City of Auburn Business License number: _BUS-35239______ _
Expiration Date of Business License: __12/31/20_______ _
Contact Person Name and Title: 1" �--.j O ( '01 R oc..,� 0\
ContactPersonE-mail: <'('0�""-0��C\\�c3c,)J.1(2 ���·,\_
Contact Person Phone: �-i5' ;0°\ °'rcrl-1 --------------
81 p oo 1
(Optional) Is this business 51% minority-owned or women-owned (Y N __ _
Please initial each to confirm:
10 or fewer employees _L I A for profit business in the City of Auburn established prior to January 1, 2020
1
DocuSign Envelope ID: 75DAC844-48E7-4BFE-B30F-F86DB8945C41
DocuSign Envelope ID: 75DAC844-48E7-4BFE-B30F-F86DB8945C41
DocuSign Envelope ID: 75DAC844-48E7-4BFE-B30F-F86DB8945C41
X
8/11/2020
DocuSign Envelope ID: 75DAC844-48E7-4BFE-B30F-F86DB8945C41