Small Business Grant Application En español Small Business Grant Application A Small Business Grant Program that will provide a one-time grant of $5,000 to small businesses that have experienced adverse financial impact due to the COVID-19 pandemic. Small Business Grant Application For PREVIEW PURPOSES only. This form does not currently accept any inputs and cannot be submitted. Subscribe to Get Notified When Active! The application period will open on Monday, September 28th at 8 a.m. and close on Friday, October 9th at 5 p.m. No applications will be accepted after the 5-day application window closes. Tell Us About You: Personal InformationFirst Name*Last Name*Primary Contact Email* Enter Email Confirm Email Primary Contact Phone Number*Tell Us About Your Business: Business InformationBusiness Name (as listed on your Business License)*Federal Employment Identification Number (FEIN) OR Tax Identification Number (TIN)*Business Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Business Website (type N/A if no website)*How many years have you been in business in the City of Antioch?*Business Category*RetailRestaurantPersonal service establishment, specifically, hair salon, barbershop, nail salon, spa, fitness studioOtherYou selected "Other". Tell us your business category*Does your business operate out of a physical, commercial location within the Antioch city limits?*YesNoDoes your business hold an active City of Antioch business license that was originally issued issued no later than January 1, 2020?*YesNoIf yes, please provide your City of Antioch Business License Number*How many employees were employed by your business as of March 1, 2020?*COVID-19 Business ImpactDid your business receive the Economic Injury Disaster Loan (EIDL)YesNoDid you receive Payment Protection Program (PPP) funding?YesNoIs your business currently closed due to the Shelter-in-Place order?*YesNoHow long has your business has been closed?*If your business is currently closed, do you have a plan for re-opening that aligns with the state and county guidelines?*YesNoPlease provide a brief narrative of the impact COVID-19 has had on your business (lost revenue, closure, suspended operations, reduced employee compensation, laying off employees, etc.).*Please describe how you would use the Small Business Grant Program funding if you were to receive the grant.*Other InformationIs your business minority-owned?*YesNoPrefer not to answerIs your business woman-owned?*YesNoPrefer not to answerPlease upload the following documentsCity of Antioch Business License*Accepted file types: pdf.Must be a PDF and no larger than 2.7 MB.IRS Form W-9*Accepted file types: pdf.Must be a PDF and no larger than 2.7 MB.Don't have a W-9? Click here to download and complete.Monthly financial records (Profit/Loss Statement) for the three months ended June 2020 (April 2020, May 2020, June 2020)*Accepted file types: pdf.Must be a PDF and no larger than 2.7 MB.Monthly financial records (Profit/Loss Statement) for the previous three-month period ended March 2020 (January 2020, February 2020, March 2020) OR monthly financial records (Profit/Loss Statement) for the same period ended June 2019 (April 2019, May 2019, June 2019)*Accepted file types: pdf.Must be a PDF and no larger than 2.7 MB.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 from the Small Business Grant Program. benefits.* I agree I do not agree The City of Antioch and Antioch Chamber of Commerce may request additional documents if necessary to verify that the business meets the program eligibility requirements.NameThis field is for validation purposes and should be left unchanged. For PREVIEW PURPOSES only. This form does not currently accept any inputs and cannot be submitted. Subscribe to Get Notified When Active!