HomeMy WebLinkAboutSERHYD_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@auburn1na.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: S°'e.rv /'Ce, Yy J CQ u..-J r CS J ?Lyi (.
Name of Business Owner(s): ftl&r� J· :Pa 111 -i/tc L <,tk·1 r\
Business Address:,?S-3-P\.., J+. NL? A-uharn, Wtl, q;JoO)--
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City of Auburn Business License number: 3 33 lj q fJ
Expiration Date of Business License: IQ. -8 / -2 D
Contact Person Name and Title: Pct (h JL/ l<-L Cl).(; h i 5<2(('(.,+a �
Contact Person E-mail: Q(.{ Du D +-f n9 ID 5£ [V j LR by drauU cf;. lom
Contact Person Phone: ;;5 :3 � 35 /-{z!J JO
(Optional) Is this business 51% minority-owned or women-owned (Y/@ __ _
Please initial each to confirm:
_f_ 10 or fewer employees
� A for profit business in the City of Auburn established prior to January 1, 2020
1
30324
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DocuSign Envelope ID: AF1EF04C-FC4F-4C47-BC47-F6004A9CCAEB
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8/11/2020
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DocuSign Envelope ID: AF1EF04C-FC4F-4C47-BC47-F6004A9CCAEB