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• HKH' EC <br /> M LON RIND AE.]Cwt o4 • �e r s eco by f�cid( <br /> s s---oy< <br /> 1 . amnia 1W3M 04 <br /> Company: go-J-jer Vert-1-1,,re s L f e' <br /> Address: r2 3S Lt) A)esf le../,/,',.e Dr.i'ue -sti.,-;ie 4 <br /> City / State / Zip D i,:^° t Pith sI LI Vt9 <br /> ContactPerson(s) l7wc•t.e. A . GoE4-s- , <br /> Business Phone 763- 792- x/990 Fax 76 3- 79-1- gi97z <br /> 1-lome Phone - 61.2 - $/O - 3670 Email goe>-i-se.�, Q c{ra..4. -eco,. eOrpt <br /> J �J <br /> Check One: Proprietor X. Corporation Z Partnership <br /> Social Security No. 321)- Cc - /6 /2 <br /> Federal ID # 070 - 0-7 9(,l r7 t State ID # Aii/A <br /> 11, t <br /> H. N4t}E CF LON FST <br /> Which Micro-Loan Program are you applying for? <br /> _Supplemental Financing Program <br /> Redevelopment Financing Program <br /> ,X industrial Incentive Program <br /> Amount Requested: $ /00, OOD Total Project Cost: ^2J : 33 <br /> . t f BA 5-6-6 <br /> Type of project: <br /> New construction For a start up business. <br /> XNew construction for an existing business. <br /> On site expansion <br /> Equipment purchase <br /> Remodeling: (circle one),Commercial/ Retail / Industrial <br /> Cather <br /> Please give a brief summary of your business and its products or sen-ice: <br /> • <br /> rvr -"1 � , r-r--7r. 1 co ; Inn-1niii.i0 1 1117rrruLn a/ C : l n 1.n CT CPi.! <br />