Business Grant Proposal Questionnaire

Point of Contact Information
Please provide the information for the person who we will be primarily contacting for the completion of this service.
Name*
First Last
Phone*
Email*
Is the point of contact the top leadership of the company?*
- Yes
- No
Is the point of contact an authorized representative for government negotiation?*
- Yes
- No
Company Information
Company Name*
Employer Identification Number (EIN)
Office Phone
Web Address
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Legal Structure*
Mission Statement*
Please provide a brief summary of the Company History
Business/Project Summary*
Top Leadership Information
Please provide information on the top leader of the company.
Name*
First Last
Title*
Provide a short bio about this person*
Is the top leadership an authorized representative for government negotiation?*
- Yes
- No
Authorized Representative for Government Negotiation
Name*
First Last
Email*
Phone*
Application Information
Total Estimated Cost for the Project (Funds Requested)*
Project Duration (Length of Time to Spend Funds)*
Brief description of the company's relevant experience and facilities to be used.*
Please upload any relevant materials. (business plan, pitch deck, etc.)
Drop files here or

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Point of Contact Information