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2. Applicant Information
4. Applicant's First Name*
5. Applicant's Last Name*
7. Business Name*
9. Business Address*
11. City*
12. State*
13. Zip Code*
15. Email*
16. Phone Number*
18. Mailing Address
    Please provide your mailing address if it differs from your business address.
20. City
21. State
22. Zip Code
24. Business Category/Type*
26. Business Information
28. Typical Monthly Revenue
29. Typical Monthly Expenses
31. Number of years in business as of March 13, 2020
32. Do you own or lease your building?

    1. Own
    2. Lease
34. Number of Full-Time Employees
35. Number of Part-Time Employees
37. Is your business current on property tax payments, sales tax remittance and Hotel Occupancy Taxes?*

    1. Yes
    2. No
39. Please provide a brief explanation of the economic effects COVID-19 has had on your business
41. Has your business received any funding from the PPP (Paycheck Protection Program) or EIDL (Economic Injury Disaster Loan)?

    1. Yes
    2. No
43. If yes, how much did you receive?
45. PPP
46. EIDL
48. Copy of the business’ quarterly wage report filed with the Texas Workforce Commission for year end 2019 or its 4th quarter form 941 for 2019. If the business is a sole proprietorship, please provide verification of such.
50. Copy of Texas Secretary of State Certificate of Filing. If sole proprietor, please provide documentation on when the business was started.
52. Business financial statements to include profit and loss statement and balance sheet for March, April and May for 2019 and 2020.
54. Company’s W-9 form.
56. Verification showing payment for business ad valorem and personal property tax to the Walker County Appraisal District in 2019.
58. Texas Comptroller of Public Accounts sales tax statement for March 2020 or most recent filing.
60. Certification
62. I agree to adhere to the COVID-19 Small Business Resource Grant Program guidelines as established by the City of Huntsville. I certify that all information submitted in this application is true and correct to the best of my knowledge.

    1. I agree
64. Privacy Information
    Information provided in this application may be considered public records and may be subject to public disclosure through the Texas Public Information Act. The City of Huntsville will endeavor to retain all submitted information on a confidential basis to the extent allowed by law. If submitted information is considered by the applicant to be confidential or protected as a trade secret, the information must clearly be marked as such.
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66. 1. Receive an email copy of this form.
67. Email address

    This field is not part of the form submission.

68. Submit

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