McAllen COVID-19 Small Business Grant Step 1 of 4 25% BEFORE YOU BEGIN Please gather all documents below before moving forward with this application. All documents must be uploaded at time of submission. The application must be completed during one session, and cannot be saved. Texas Secretary of State Texas File number State of Texas License number DBA 2018 or 2019 tax return (return only, schedules not required) Social Security Number Employer Identification Number, or Individual Taxpayer Identification Number. For a sole proprietor, applicants provide 2018 or 2019 Schedule C of the tax return. Applicant InformationApplicant Name (Owner)* First Last Phone*Email* Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code SSN*Texas Driver License Number*Percentage ownership over the company* Business InformationBusiness Name*Date Established* Date Format: MM slash DD slash YYYY Ownership Type* Sole Proprietor General Partnership S-Corporation C-Corporation Limited Liability Company Limited Liability Partnership Employer Identification Number (EIN); (SSN if Sole Proprietor)*Texas Secretary of State File NumberPhysical Business Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Zip Code Mailing Address (if different from physical business address) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Number of employees as of February 15, 2020*Number of current employees*How many owners does the company have?*Gross Receipts for 2019* Owner 2 (if applicable)Name First Last SSNTexas Driver License NumberPercentage ownership over the companyPhoneEmail Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code If additional owners, please upload additional documents with informationFull Name, SSN, Percentage ownership, Phone Number, Email, AddressFile Purpose of the requested funds* Launching online presence and sales PPE and sanitation supplies and equipment Short-term Marketing Campaign Limited interior modification for health and safety purposes Delayed rent/mortgage payment for business property Delayed utility payment for business property Replenishing Inventory Select all that applyPlease upload the following documents*Texas Secretary of State Texas File number; If the business is a Partnership please upload IRS Form 1065; If the business is an S-Corporation please upload IRS Form 1120-S; If the business is a C-Corporation please upload IRS Form 1120; If the business is a Sole Proprietor or single-member LLC please upload IRS Form 1040 Schedule C. Tax returns must be from 2018 or 2019. Drop files here or COVID-19 Economic Impact Statement* I hereby state that the COVID-19 Pandemic has adversely impacted my business by causing loss of income, sales, employment, hours of operation, and customers, as well as causing inventory disruption, production delays, negative regulatory changes, workforce changes, and significant loss of business contracts. This adverse impact also includes other government actions, such as shelter-in-place orders and having been deemed a non-essential business. Audit and Claw-Back Provisions* By accepting the McAllen COVID-19 Small Business Grant, I agree to allow the possible audit and/or review by the City of McAllen of the use and distribution of the funds from the grant for the benefit of my business. In addition, I also agree that if the money allocated is misused, i.e., used or distributed for purposes other than for what is qualified under the McAllen COVID-19 Small Business Grant, I will be required to pay back the money granted and misused.Consent* I hereby certify that the above statements are true and correct to the best of my knowledge. I understand that a false statement may disqualify me for benefits. I attest that all of the information on this application is true. I authorize the City of McAllen and the McAllen Chamber of Commerce to investigate and verify the above information and contact any references regarding this application. I also authorize to perform a criminal background check, as authorized by law. The release of all information by the City of McAllen and the McAllen Chamber of Commerce in any manner is hereby authorized whether such information is of record or not and I hereby release all persons, agencies, firms, companies, etc., from any damages resulting from such information. I understand that the City of McAllen and the McAllen Chamber of Commerce will make a final decision whether the grant is approved or denied and that I can’t appeal the final decision if the benefits are denied. I attest that the funds are necessary due to conditions caused by COVID-19. I agree to be audited for the use of grant funds received.Signature
