HomeMy WebLinkAboutCAMFG_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 go,.
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
Na me of Business, C a_s, c¼ t-\f q ..i. 0 t � t-. C:u . I I\( -
Name of Business Owner(s): Do(\() (6,,,(ll.Sa{)
Business Address: /) 2:':f 2 °I tt\ �-I ow � I a\ Auiu.vn q 8 06 I
City of Auburn Business License number: _BUS-25040_ _
Expiration Date of Business License: _12/31/2020___ _
C!IM��HmM N�l'i\E, and Me: l .W.!.Y'l-P Si (hf✓t.lrl-VILJ fleJ;td,liJ:
Contact Person E-mail: ±heca.ptd.i C()w � �\\I UJM
Contact Person Phone: d'�� 7'?Jlo 7-0 3 2
(Optional) Is this business 51% minority-owned or women-owned (Y/N) _N_o_
Please initial each to confirm:
_Lt_ 10 or fewer employees
Ll._ A for profit business in the City of Auburn established prior to January 1, 2020
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DocuSign Envelope ID: 0359B919-0C60-499F-88C9-B3AD9C2F9651
DocuSign Envelope ID: 0359B919-0C60-499F-88C9-B3AD9C2F9651
DocuSign Envelope ID: 0359B919-0C60-499F-88C9-B3AD9C2F9651
8/18/2020
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DocuSign Envelope ID: 0359B919-0C60-499F-88C9-B3AD9C2F9651