CARES Act Grant for Surfside Small Businesses Application Form

The following documents are required to be considered for this grant. Incomplete applications will not be considered. Please use the below as a checklist to ensure your application is complete upon submission.

This completed application form
Copy of SunBiz page, showing business has been in operation for at least 1 year
Copy of active State of Florida Corporation and/or Fictitious Name (can be found on SunBiz if applicable)
Copy of Photo ID (driver's license or State ID)
Business federal income tax return of 2019 (2018 if 2019 is unavailable or incomplete)
CARES Act Compliance Affidavit
W-9 Form for your business

All documents must be submitted through this form. Documents mailed or dropped off at any Town offices will not be considered. Applicants may send each document as separate attachments OR may include them all in one (1) PDF.

Business Name

As it appears on Sunbiz

Business Address

Owner's Name

Owner's Primary Phone Number

Alternative Phone Number

Owner's Primary Email Address

Owner's Home Address

Preferred Mailing Address

Type of Business

Business FEI/EIN

Brief description of your business:

Please describe in detail how your business has been affected by the impact of COVID-19:

How will the grant funds be used (be specific):

File upload

Please confirm that you have attached all relevant files. The list of documents needed are in the checklist at the top of this form.