Business Name *

Include both your legal business name and DBA

Primary Contact Name *

Title *

Mailing Address Including City, State, ZIP *

Primary Contact Phone *

Primary Contact E-mail *

Business Website *

Business Type: *

(select one)

Enter required value Sole Proprietorship Other Partnership LLC S-Corp C-Corp Nonprofit

Year Business Established *

Number of Full-Time Employees *

(Including owner)

Number of Part-Time Employees *

Annual Revenue Range: *

Enter required value Under $100,000 $100,000–$250,000 $250,001–$500,000 $500,001–$1,000,000 Over $1,000,000

Briefly describe your business and the products or services you provide. *

(250 words or less)

Describe how change has created a need for investment or adaptation in your business. *

Examples may include infrastructure expansion, new competition, shifting customer patterns, increased demand, or other changes in your business environment. Be as specific as possible. (300 words or less) 

How has change in your current business environment affected your operations, revenue, or customers? *

Please include what investment is needed to respond. Provide any specific examples, numbers, or timeframes if available. (300 words or less) 

How long has your business been navigating this period of change? *

Enter required value Less than 6 months 6-12 months More than 12 months Ongoing / indefinite

Describe specifically how you would use the grant funds. *

What will you purchase, upgrade, or invest in? (250 words or less) 

How will this investment help your business? *

Please describe how your business will adapt, grow, or better serve your customers in the context of the changes described above. (250 words or less)

What is the expected timeline for using these funds if awarded? *

Enter required value Within 30 days 30-90 days 90 - 180 days 180+ days

Have you received other grants, loans, or financial assistance in the past 12 months? *

Yes

No

If yes, please describe the source and amount:

How long has your business been located in Chatham County? *

Do you employ Chatham County residents? *

Yes

No

If yes, approximately how many?

Is there anything else you would like the review committee to know about your business or situation?

(150 words or less)

By submitting this application, I certify that: *

• The information provided is accurate and complete to the best of my knowledge.
• My business is currently operating in Chatham County, North Carolina.
• I understand that grant funds must be used for the purposes described in this application.
• I agree to provide a brief follow-up report to the Chatham Chamber within 90 days of receiving funds, describing how funds were used and the impact on my business.
• I understand that submitting an application does not guarantee an award.

I agree

Questions:

Contact: Rebecca Dickenson | rebecca@chathamchambernc.org | 984-265-9172

This program is funded by the Duke Energy Foundation through the Powering Local Economies grant initiative.