For the Love of Geyserville Relief Fund - Application for Business Grant
Email address *
Business Type *
Business Legal Name
Business TIN (EIN, SSN)
Business License Number
Business Address
Phone Number
Name of Primary Contact
Number of Full-Time Equivalent (FTE) Employees (as of March 1st, 2020) How do I calculate a Full-Time Equivalent #? Divide the hours worked by an employee bythe hours in a workweek. If you assume a 40 hour workweek, and an employee works 15hours, then that is 15/40 or 0.375 FTE.
Purpose of Grant (you may select more than one)
Please list all owners of 20% or more of the equity of the Applicant (Owner Name, Owner Title, Ownership %, TIN (EIN, SSN), Address)
Grant Amount Requesting (upper limit is $3,000)
My business is a for-profit business that is located within the Geyserville town limits, and has a “brick and mortar” presence here.
Clear selection
My business has been in business in Geyserville since at least March 1, 2020.
Clear selection
My business has been adversely impacted because of the COVID-19 crisis and related public health orders.
Clear selection
I will be using the grant funds for my business’ personnel costs (wages, benefits), lease or mortgage payments, utilities, or materials and supplies to help improve my business’ ability to re-open with distancing orders.
Clear selection
I have attempted in good faith to apply for a Paycheck Protection Program (PPP) loan from the Small Business Administration (SBA) and did NOT receive a PPP Loan.
Clear selection
As related to the above certification on your PPP loan application, please elaborate on the below, as applicable: Please explain why you did not apply for a PPP loan OR I applied for a PPP loan but do not know if I will receive a loan. The amount I applied for is $___ OR I applied for and have secured funds for a PPP loan in the amount of $___ Please note, if you have secured funds for and/or have received a PPP Loan, you may still apply for this grant, but preference may be given to those applicants who, despite a good faith effort, were unable to get a PPP Loan.
I acknowledge that the grant funding source is limited, and that I may not receive the grant amount I have requested or any grant amount at all if the program is oversubscribed.
Clear selection
I am not (and nor have any individuals owning 20% or more of the equity in my business been) subject to indictment, criminal information, arraignment, or other means by which formal criminal charges are brought in any jurisdiction, or presently incarcerated, or on probation or parole.
Clear selection
Within the last 5 years, for any felony, I have not, nor has any owner of my business: 1) been convicted; 2) pleaded guilty; 3) pleaded nolo contendere; 4) been placed on pretrial diversion; or 5) been placed on any form of parole or probation (including probation before judgment).
Clear selection
I am eligible to receive a grant under the rules in effect at the time this application is submitted and as stated on this application.
Clear selection
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