Equipment Grant Application

Qualifications:

Must have a minimum of seven Full Time Employees whose average pay is equal to or greater than $30,000 and the business must offer medical benefits where the employee pays no more than 50% of premiums.
The business must have annual revenues of more than $1 million.

Contact Information

Company name*

First name*

Last name*

Street address*

City*

State/Region*

Postal code*

Business owner email address*

Business phone number*

Business Owner mobile phone number*

Website or Facebook URL*

N/A if not applicable

Business Information

Business opening date*

Month/Day/Year

How long has owner or business contact been in this type of business?*

Number of full time employees*

Must have seven or more FTE

Number of part time employees*

Average wage of all employees*

Include average $/hour or annual salary

Project Information

Tell us about your project*

What equipment do you need assistance with? Include timeline to purchase, install and explain financial need.

Will this equipment purchase increase the number of jobs? If so, how many?

Estimated total cost of equipment to be purchased*

Include installation cost and be prepared to provide quotes for all items.

Will this project or equipment purchase increase sales?

If this project will increase sales, provide the sales projection for the next two years.

*Submitting this form will begin the process of applying for the Equipment Grant. Note you will be required to submit the following documents as you proceed through the application process: