Thurston Strong Micro-Business Standup Grant Application July 1, 2020 October 13, 2020 Name of business:*Email:* Telephone*Physical address:* Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code UBI #:*Number of FTE employees:*Type of business:*RetailFood/BeverageOffice/Professional ServicesEntertainmentChild CareHealth CareConstructionDistribution/LogisticsManufacturingPhysical location:*(Select all that apply, must be physically located in Thurston County) Lacey Olympia Tumwater Other Thurston County Is this a minority-owned business?*YesNoProposed use of grant funding:*(Select one or more) Rent or mortgage support Location cleaning Safety supplies Inventory purchases Physical site reconfiguration Business licensing or other related reconfiguration fees or expenses Employee assistance (e.g. transportation, gear) Other (other uses may be considered if compelling and not an expense that has or will be paid for using other federal funding – e.g. PPP or EIDL programs) Other use:Please check the appropriate box if you’ve received either of the following: City of Lacey Business Grant Working Washington Grant Amount of grant funding you are requesting:*(*Receipts required)$1,500.00Amount less than $1,500.00Amount:Please certify that your business has experienced harm as a direct result of the COVID-19 pandemic and grant funds will be used to mitigate impacts or offset costs incurred during your associated recovery efforts. Thank you!*Certify that this business has experienced harm as a direct result of the COVID-19 pandemic and grant funds will be used to mitigate impacts or offset costs incurred during associated recovery efforts. Click here to certifyTo receive funds, you will be asked to submit a W-9 form. Please certify you understand this below.*I agree to submit a W-9 form. Click here to certify*Please note, it may take 2-4 weeks to process grant applicationsCommentsThis field is for validation purposes and should be left unchanged.