Matching Grants

Business Information

Company Name

NAICS Code

Employer Identification Number (EIN)

Company Address

Community where applicant business is located (Town, Village, City)

Full Name of Contact Person

Title of Contact Person

Contact Person Phone Number

Contact Person Email Address

Number of Employees

Annual Gross US Sales

Were you referred by someone to this program? If yes, please provide their name.

Describe your Business

Upload supporting W-9 if available

BACK - ELIGIBILITYNEXT- USES OF FUND

Uses of Funds

If applicable, describe the consultant services for training or marketing

If applicable, provide itemized consultant costs, including a total and amount being requested from the matching grant program

Has your business been impacted by the COVID 19 pandemic? If so, describe below including any impact on employment

BACK - BUSINESS INFONEXT - SIGNATURE

Grant Signature

In signing this application on behalf of the requesting business, I hereby certify:

1. That all information is complete and correct;

2. That the business is a Racine County for-profit company;

3. That the business is an existing business, has a physical location that is not home-based and has been open (since date of first revenue) for a minimum of 30 days;

4. That the business has less than 200 employees at its Racine County location;

5. That the business has less than $25 million in gross annual US sales;

6. That the business is working with one of the following organizations: RCEDC, Gateway Technical College, RAMAC, WWBIC, SBDC or an independent consultant as described on the first page of this application document which can include the RCEDC CEO Roundtable program, the RCEDC/RAMAC Living as a Leader program or the RCEDC Coaching Council program;

7. That the business and owners are current with Racine County Real Estate Taxes and have no derogatory findings with Wisconsin Circuit Court Access or the Wisconsin Department of Financial Institutions;

8. That the business certifies that they have no outstanding fines, penalties, taxes, or delinquent financial obligations whatsoever with the County of Racine, Wisconsin, agency, entity or any other local unit of government;

9. That the business agrees, one year after the grant is provide, to provide an email or a memorandum, on company letter head, the number of jobs at the time of the grant application and the number of jobs one year after the grant was received and outlining the impact of the grant program on the business;

10. That the business and/or its affiliates have not received the maximum cumulative amount of grant funds of $15,000;

11. That the information provided may be subject to open records under Wisconsin law, although not all information in them may be subject to disclosure. I recognize that, with respect to any funds granted, the following information, at a minimum, will be treated as subject to disclosure to a person making a request under Wisconsin public records law: the amount of the grant, name and address of party to whom the grant was granted, the purpose of the grant, and names of any other parties involved in the grant;

12. That all grants are approved based on the RCEDC Loan Committee discretion

Full Name of Person Filling Application

Title of Person Filling Application

Today's Date

I hereby certify that, to the best of my knowledge, the provided information is true and accurate.

BACK - USES