Business Grant Proposal Questionnaire

Contact Name:*
Company Name:*
Contact Email:
Employer Identification Number (EIN) :
Phone:
Mobile Phone:*
Office Phone:
Web Address:
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Legal Structure:*
( Ex: nonprofit, LLC, S-Corp Partnership, Other)
Please provide a brief summary of the Company History
Business/Project Summary:*
Mission Statement:*
Name(s), Title & a Short Bio's on the top leadership:*
Contact info of authorized representative for government negotiation purposes (If different from above).
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:*
If any, please upload any other relevant materials: (Add Business plan, pitch deck, etc.)
Drop files here or

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