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2. Notice:

   You are providing this application, financial and other proprietary information to the Fredericksburg EDA under a promise of confidentiality and FOIA non-disclosure under Virginia Code Section 2.2-3705.6 subpart 3.

   Business applicants must have an operating business office and/or store located in the City of Fredericksburg (22401) to be eligible for InvestFXBG. Applicants are required to pay and be in compliance with all applicable City of Fredericksburg taxes, permits, fees and regulations prior to applying.

4. Business Name*
6. Physical Address (must be located in the City of Fredericksburg, zip code 22401)*
8. Mailing Address/P. O. Box
10. City*
11. State*
12. Zip Code*
14. Contact Number*
15. Fax Number
16. Web Address*
18. Applicant Main Contact*
19. Main Contact Title*
21. Telephone Numbers*
22. E-Mail Address*
24. Describe ownership of business*
26. Business address and location if different from above
28. Number of years in operation*
29. Number of years at current location*
31. Location owned or leased?*
32. If leased, what is the remaining term of lease?
34. If leased, name of landlord
35. If leased, landlord contact information
37. Describe the applicant's business operations, including services, products sold, number of employees, growth plans*
39. Describe the applicant's proposed use of EDA funds*
41. Amount of loan funds requested (general limit of $50K)*
43. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
45. Electronic Signature*
46. Date*
    Date

    Date
Leave This Blank:


48. 1. Receive an email copy of this form.
49. Email address

    This field is not part of the form submission.

50. Submit Submit and Print

* indicates a required field