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2. Legal Name of Business Entity
4. Contact Person
5. Title
7. Business Address
9. Phone
10. Email address
12. Legal structure of business

    1. Corporation
    2. LLC
    3. Sole Proprietorship
    4. Other
13. Business EIN
14. DUNS Number
18. OWNERSHIP
20. Name
21. Percentage of Ownership
23. Name
24. Percentage of Ownership
28. SECTION 2 - BUSINESS ACTIVITY AND FUNDING
30. Business Activity Information
32. 1. Provide a description of how your business has been affected by COVID-19 restrictions including, but not limited to, any reduction in staff, furloughs, lay-offs or closures.
34. 2. Between March 1, 2020 and the date of your application, has your business been closed due to COVID-19 restrictions?

    1. Yes
    2. No
36. 3. What is your current business situation? Are you currently open/operational?

    1. Yes
    2. No
38. 4. If open, have the hours of operation been reduced?

    1. Yes
    2. No
40. If Yes, please provide an explanation.
42. 5. Provide a description of how COVID-19 funds will be used, including how they will impact your business operation.
44. 6. Who will be responsible for overseeing the grant funding?
46. 7. To be eligible for this grant the business must have made $15,000 - $2,000,000 in revenue (gross receipts and sales) in 2019. Does your business meet this qualification?

    1. Yes
    2. No
48. 8. To be eligible for this grant the business must have made $25,000 - $ 2,000,000 in revenue (gross receipts and sales) in 2020. Does your business meet this qualification?

    1. Yes
    2. No
50. 9. Does your business have 50 or fewer full-time equivalent employees (including part-time and full-time employees, contractors, and owners)?

    1. Yes
    2. No
54. SECTION 3 - CERTIFICATION STATEMENTS
56. Conflict of Interest Statement
58. The conflict of interest provisions will apply to any person who is an employee, agent, consultant, officer, elected or appointed official of the recipient, of any designated public agencies, or sub recipients that are receiving COVID-19 funds.
60. 1. Are you or any of the business employees a Town of Argyle employee?

    1. Yes
    2. No
62. 2. Are you or any employees elected officials with the Town of Argyle, related to anyone employed by the Town of Argyle, related to elected officials of the Town of Argyle or related to someone reviewing this application?

    1. Yes
    2. No
64. If yes, please list (name and relationship)
66. 3. Does your business entity conduct business with any person or department with the Town of Argyle?

    1. Yes
    2. No
68. If yes, please list (name and relationship)
70. Do you have a current Driver's license or government-issued photo ID?

    1. Yes
    2. No
72. Proof of Business Registry with Texas Secretary of State
74. Q4 2021 Form 941, Q4 2021 payroll report, or Q4 2021 check copies to verify number of employees
76. Business utility bill (water, gas, electric). Home based business may provide a home utility bill.
78. Business Financials: 2019 and 2020 business tax returns (additional finanical documents, such as bank statements, or P&L may be requested if losses cannot be verified by the tax returns). Applicants without a tax return for either year will not be considered.
80. I certify that all information provided as part of this application is true and correct to the bast of my knowledge. I give my consent to the Town of Argyle to use the information provided herein for the purpose and consideration of awarding grant funds for small business assistance.
82. Full name
83. Request Date*
    Request Date
Leave This Blank:


85. 1. Receive an email copy of this form.
86. Email address

    This field is not part of the form submission.

87. Submit

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