Rescue Small Business Relief Application

Are you a U.S. Citizen?

Yes
No

Are you an enrolled citizen of Tlingit and Haida?

Yes
No

Is the business at least 50% owned and operated by the tribal citizen applying for this relief grant?

Yes
No

Please enter information about you below

Tribal Enrollment Number:

Requested Grant Amount:

Applicant/Authorized Representative Name:

Date of Birth:

Social Security No.:

Job Title:

Home Phone:

Cell Phone:

Work Phone:

Mailing Address:

Address Line 1:

City:

State:

ZIP Code:

APPLICANT BUSINESS INFORMATION

Business TIN (EIN,SSN):

Length of Ownership (Years/Months):

Permit No. if Applicable:

Enter N/A if not applicable

DBA or Trade Name if Applicable:

Enter N/A if not applicable

Business Legal Name:

Name of Primary Contact if Different From Business Owner:

Enter N/A if not applicable

Business Address:

Same as Mailing Address?

Yes
No

Address Line 1:

City:

State:

ZIP Code:

Business Phone:

Business Fax:

Business Email Address:

Industry Type (select one):

Business Type (check one):

Sole Proprietor
Independent Contractor
Partnership
Commercial Fishing
LLC
Eligible Self-Employed Individual
other

If other:

Please upload document to submit