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Glacier County Regional

Port Authority

Economic Development Fund Application

A comprehensive written business plan must be attached, which must include the following

Executive Summary, Management & Organization Plan, Product/Service Plan, Marketing Plan,

Financial Plan. Applications with incomplete business plans will not be considered.

BASIC INFORMATION

Applicants Name

Title

Address

Applicants Email

Applicants Phone Number

Name of Business/Organization

Address

City

Number of Employees

Type of Business/Organizaton

Sole Proprietorship

Corporation

Partnership

Non-Profit

LLC

Zipcode

Tax ID#

Year Established

Applicants Social Security Number

(if business is a sole proprietorship)

Other contact(s)/application assistance providers

Name

Name

Name

Telephone #

Telephone #

Telephone #

Have you ever filed personal or corporate bankruptcy?

Yes

No

If yes, please explain

How did you hear about the Glacier County Regional Port Authority's Economic Development Fund?

NATURE OF THE LOAN/GRANT REQUEST

Type of Project

New Business

Business expansion/renovation

Community facilities/services

Grant/Loan Parameters

For Profit Business

No more than $5,000.00 may be requested as grant funds

Small Business Loan cannot exceed $10,000.00

Non-Profit Entities

No more than $10,000.00 may be requested/granted per project

Amount of funding request $

Total project cost $

#of existing jobs

Number of jobs to be created

Number of jobs retained

Are you interested in a GRANT or LOAN or BOTH?

Grant

Loan

Will this project be completed within 12 months after receiving funding?

*Updates of project, along with report upon completion will be required.

Yes

No

Detailed description of the development project:

Area to be served

Explain need for funding from Glacier County Regional Port Authority:

Please describe other funding sources and amounts for this project:

If awarded a grant or loan, please explain how you will recognize the Glacier County Regional Port Authority in your project or business:

TO BE SIGNED BY APPLICANT

I have willfully furnished this confidential information to the Glacier County Regional Port Authority for the purpose of applying for a loan/grant.I understand that this information will be reviewed by the Port Authority Board. I further understand that this information will become available to the Economic Development Fund Review Committee.

By signature below, I certify that this business/organization and the project proposed are in compliance with local, state and federal laws and guidlines.

Applicant Signature

Select a date

Applicant's Printed Name

Company/Organization Name

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