HomeMy WebLinkAboutRBKMA_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 CO_MPLETED BY APPLICANT
Name of Business:
Name of Business Owner(s): /-A(l(�/(Et--JL€/2-, ti'-<:>y u-fol---f,4-.5 1 lJ� f')�NAJ2-�
Business Address: 3o y'O 6 .St .,./ 0 51�.s' A�( tvA-rtoD { City
of Auburn Business License number: -Bus-03806----
Expiration Date of Business License: __12/31/2020____ _
Contact Person Name and Title: ,L{l� l�-,.,tG?fL. �1"b�,,Jr
Contact Person E-mail: MUl=a.. tl-r:,K..t<-1FG . 0...Df-1 Contact Person Phone: --�---=---=f-:'--...... �L__8--o __ Y.,__-=-8-£-=J::;...._G __ _
{Optional) Is this business 51% minority-owned or women-owned {Y /N) __ _
Please initial each to confirm:
A/'. D � P��tlfv?c...C 07YPL4>Y��--10 or fewer employees , L-VS OH<=
@ A for profit business in the City of Auburn established prior to January 1, 2020
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DocuSign Envelope ID: FEE8F40C-5271-4E4A-803C-7117C48F18D1
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8/31/2020
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