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economic development assistance programs

Economic Development Assistance Programs Pre-Application Form

Please fill out the following information:

  Information

 

 Company/Organization Name

  

 Service Address

  

 City

  

 State

  

 ZIP

  

Contact Person

  

 Title

  

 Phone

  

 Fax

  

 E-Mail

  

 Confirm E-Mail

  

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 Mailing Address

  

 

 Same as service address

 Street Address

  

 City

  

 State

  

 ZIP

   

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  

 Applying For

Brownfield/Building Redevelopment Program
Utility Infrastructure Investment Program
Capital Investment Incentive Program
Business Energy Efficiency Assistance Program
Economic Development Outreach Program
Other

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 Project Information

  

Project Description

  

Project Location

  

Jobs Created

  

 Jobs Retained

  

 Total Project Cost

  

 Requested Funding Amount

  

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 Project Schedule

  

 Start Date

  

 Completion Date

  

 

Submission of this pre-application electronically constitutes a signature by the applicant.
The applicant hereby certifies that the information provided in this pre-applications is true
and accurate in all respects.