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Butte Microbusiness COVID-19 Relief Grant Application

Butte Microbusiness COVID-19 Relief Grant Application

Date(Required)

MM slash DD slash YYYY

Business legal name(Required)

Primary business owner’s name(Required)

First Last

List names of other business owners (if any) with 20% or more ownership of the business

Name

Ownership %

Business street address(Required)

Street Address Address Line 2 City ZIP / Postal Code

Phone(Required)

Email(Required)

Business mailing address (if different)

Street Address Address Line 2 City ZIP / Postal Code

Did this business receive an award from the California Small Business COVID-19 Relief Grant Program?(Required)

Yes

No

Number of CURRENT full-time employees (FTE) as of the date of this application (30+ hour per week equals 1.0 FTE; a part-time employee working 29 hours or less per week equals 0.5 FTE)(Required)

Average number of full-time employees IN 2020 (30+ hour per week equals 1.0 FTE; a part-time employee working 29 hours or less per week equals 0.5 FTE)(Required)

Average number of full-time employees IN 2019 (30+ hour per week equals 1.0 FTE; a part-time employee working 29 hours or less per week equals 0.5 FTE)

2019 Annual gross revenue (must be under $50,000)(Required)

Date the business was established (must be prior to December 31, 2019)(Required)

MM slash DD slash YYYY

Business type(Required)

Accommodation and food services

Agriculture

Arts, entertainment, and recreation

Construction

Finance and insurance

Healthcare

Manufacturing

Professional, scientific, and technical assistance

Real estate

Retail

Transportation and warehousing

Other

Other Business Type(Required)

Primary owner gender (optional)

Female

Male

Prefer not to say

Primary owner ethnicity (optional)

American Indian/Alaska Native

Asian

Black or African American

Hispanic/Latino/a

Native Hawaiian or other Pacific Islander

Two or more races

White

Other

Prefer not to say

Other primary owner ethnicity(Required)

Is the primary owner a veteran? (optional)

Yes

No

Prefer not to say

Please explain how your business has been impacted by the COVID-19 pandemic(Required)

How do you plan to use the $2,500 grant (check all that apply)(Required)

The purchase of new certified equipment including, but not limited to, a cart

Investment in working capital

Application for, or renewal of, a local permit including, but not limited to, a permit to operate as a sidewalk vendor

Payment of business debt accrued due to the COVID-19 pandemic

Current/valid government issued photo ID (state, domestic, or foreign)(Required)

Max. file size: 50 MB.

One of the following that includes the business owner’s name:(Required)

Current/valid business license OR Fictitious Business Name Statement OR Seller’s Permit OR current business bank statement OR 2019 Federal Tax Returns

Max. file size: 50 MB.

I certify that I am the majority-owner and manager of the business and that it was my primary means of income during the 2019 taxable year.(Required)

I agree

I certify that I am authorized to sign on behalf of all owners listed in this application.(Required)

I agree

I authorize 3CORE to make inquiries as necessary to verify the accuracy of the statements made and to determine my creditworthiness.(Required)

I agree

I declare under penalty of perjury that all the information submitted in this application is true and correct.(Required)

I agree

Digital Signature

By typing your full name below using any device, means or action, you consent to the legally binding terms and conditions of this program. You further agree that your signature on this document (hereafter referred to as your "E-Signature") is as valid as if you signed the document in writing.

Applicant's Name(Required)

The CA Microbusiness COVID-19 Relief Grant Program is administered by 3CORE, Inc.