Business Eligibility
Are you a for-profit Racine County company? Yes No
Are you Applying for an established business? Yes No
Does the business have a physical location that is not home-based? Yes No
Has the business been open and generating revenues for a minimum of 30 Yes No
Do you have less than 200 employees at your Racine County location? Yes No
Does the Business have less than $25 million in US gross sales? Yes No
Are you currently working with one of the following Racine County organizations (check all that apply)? RCEDC Gateway Technical College RAMAC WWBIC SBDC Independent Consultant Considering the RCEDC CEO Round Table Considering the RCEDC/RAMAC Living as a Leader Program
Ownership of 51% or more by: Racial or Ethnic Minority Woman Veteran Other
Is the business a manufacturing companies? Yes No
Are you current with Racine County Real Estate Taxes? Yes No
Are you current with all financial obligations with Racine County, Wisconsin, or any other local unit of government, and have no outstanding fines, penalties, taxes or other financial obligations owed to these entities? Yes No
Has the applicant business or any of its affiliates previously received grant funds from this program? Yes No
If Yes, Business that received funds If Yes, total grant funds received
Have you identified eligible costs to grow your business, such as consultant costs for training or marketing? Yes No
Note: If the applicant business or any of its affiliate businesses have previously received grant funds, they only qualify for a cumulative amount of $15,000 after which applicants no longer qualify to receive grants.
NEXT - BUSINESS INFO
Business Information
Company Name
NAICS Code
Employer Identification Number (EIN)
Company Address
Community where applicant business is located (Town, Village, City)
Full Name of Contact Person
Title of Contact Person
Contact Person Phone Number
Contact Person Email Address
Number of Employees
Annual Gross US Sales
Were you referred by someone to this program? If yes, please provide their name.
Describe your Business
Upload supporting W-9 if available
BACK - ELIGIBILITY NEXT- USES OF FUND
Uses of Funds
If applicable, describe the consultant services for training or marketing
If applicable, provide itemized consultant costs, including a total and amount being requested from the matching grant program
Has your business been impacted by the COVID 19 pandemic? If so, describe below including any impact on employment
BACK - BUSINESS INFO NEXT - SIGNATURE
Grant Signature
In signing this application on behalf of the requesting business, I hereby certify:
1. That all information is complete and correct;
2. That the business is a Racine County for-profit company;
3. That the business is an existing business, has a physical location that is not home-based and has been open (since date of first revenue) for a minimum of 30 days;
4. That the business has less than 200 employees at its Racine County location;
5. That the business has less than $25 million in gross annual US sales;
6. That the business is working with one of the following organizations: RCEDC, Gateway Technical College, RAMAC, WWBIC, SBDC or an independent consultant as described on the first page of this application document which can include the RCEDC CEO Roundtable program, the RCEDC/RAMAC Living as a Leader program or the RCEDC Coaching Council program;
7. That the business and owners are current with Racine County Real Estate Taxes and have no derogatory findings with Wisconsin Circuit Court Access or the Wisconsin Department of Financial Institutions;
8. That the business certifies that they have no outstanding fines, penalties, taxes, or delinquent financial obligations whatsoever with the County of Racine, Wisconsin, agency, entity or any other local unit of government;
9. That the business agrees, one year after the grant is provide, to provide an email or a memorandum, on company letter head, the number of jobs at the time of the grant application and the number of jobs one year after the grant was received and outlining the impact of the grant program on the business;
10. That the business and/or its affiliates have not received the maximum cumulative amount of grant funds of $15,000;
11. That the information provided may be subject to open records under Wisconsin law, although not all information in them may be subject to disclosure. I recognize that, with respect to any funds granted, the following information, at a minimum, will be treated as subject to disclosure to a person making a request under Wisconsin public records law: the amount of the grant, name and address of party to whom the grant was granted, the purpose of the grant, and names of any other parties involved in the grant;
12. That all grants are approved based on the RCEDC Loan Committee discretion
Full Name of Person Filling Application Title of Person Filling Application Today's Date
I hereby certify that, to the best of my knowledge, the provided information is true and accurate.
BACK - USES
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