NJRA Grant Application

Small Business Lease Emergency Assistance Grant Program

For program details, please see: https://njra.seamlessgov.com/formcenter/covidgrant

Funding is subject to Program Funds availability. Due to high demand, this funding may be exhausted, but submitting your application will ensure that if additional funds become available for this round of Grant funding, you may be eligible. Applications will be reviewed based on first come, first submitted basis.

The application period will close at 10am EDT on Tuesday, August 11, 2020.

Phone Number

Name of Business

Nature of Business

Does your business have a federal Employer Identification Number (EIN)?

Yes

Employer Identification Number (EIN)

Taxpayer Identification Number (TIN)

Business Designations

Woman-owned business

Minority-owned business

Veteran-owned business

Landlord Name

Landlord Phone Number

Landlord Email

Lease Start Date

Lease Duration (e.g. 1, 6)

Lease Duration Unit

Date of Last Lease Payment

Please upload a copy of your lease

Click Here to Upload

Have you been convicted and/or found guilty and/or pled guilty and/or found liable and/or paid a fine or otherwise paid to settle any allegations made by the government in any court to any violation of law, other than minor traffic offenses?

Yes

Please explain:

Have you been denied a license or permit required to engage in its business or profession or has any such license or permit or been suspended or revoked by any government?

Yes

Please explain:

I, THE UNDERSIGNED, BEING DULY SWORN UPON MY OATH SAY:

I understand that if such information is willfully false, I am subject to criminal prosecution under N.J.S.A. 2C:28-2 and civil action by the NJRA.
I authorize the NJRA to contact my landlord in connection with the Small Business Lease- Emergency Assistance Grant Program.
I am not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transaction by any Federal Department or agency, or by the State of New Jersey.
I declare my business has never violated the terms of a State/Public agreement or transaction that resulted in any criminal or civil charges by a government business.
I authorize the NJRA to provide information submitted to it by or on behalf of the applicant to any bank or State agency which might participate in the requested grant with the NJRA.
I acknowledge and understand that Title 18 United States Code Section 1001: (1) makes it a violation of federal law for a person to knowingly and willfully (a) falsify, conceal, or cover up a material fact; (b) make any materially false, fictitious, or fraudulent statement or representation; OR (c) make or use any false writing or document knowing it contains a materially false, fictitious, or fraudulent statement or representation, to any branch of the United States Government; and (2) requires a fine, imprisonment for not more than five (5) years, or both, which may be ruled a felony, for any violation of such Section.
I authorize that an electronic signature of this Application and any Approval Letter, Grant Agreement, or Certification shall be a binding on the parties.

I CERTIFY THAT THE INFORMATION PRESENTED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE.

Sign Here

First Name

Last Name

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I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.

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