American Rescue Plan Act Letter of Interest

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* 1. Legal name of Organization/ Small business

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* 2. Address of Organization/ Small business

Name

Company

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

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* 3. Are you a small business or Nonprofit?

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* 4. What is your amount of support you are requesting?

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* 5. Federal Tax ID Number