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Lehigh and Northampton Grant Application

  • Contact Information

  • Company Information

  • Including city and zipcode.
  • Name/Title% of Ownership 
  • Sales Data ( Gross Sales, Gross Receipts, Gross Revenue)

  • First Quarter 2019

  • Second Quarter 2019

  • Third Quarter 2019

  • Fourth Quarter 2019

  • First Quarter 2020

  • Second Quarter 2020

  • Third Quarter 2020

  • Fourth Quarter 2020

  • Employee Data

  • Other Covid Assistance Received

  • Please note, funding will not be awarded to pay for the same expenses that you have already received payment or reimbursement from other COVID-19 related programs.
  • Supporting Documents Required for Complete Application:

    • Business Tax returns for 2019 and 2020, if completed
    • Quarterly Financial Statements or Sales, Use, and Hotel Occupancy Tax Form PA-3 for 2019 and 2020, including profit and loss
    • Proof of Business Organization (Certificate of Organization, Articles of Incorporation, or Fictious Name Filing)
    • W-9
    • Copy of Business Owners Driver's License
  • Drop files here or
    Accepted file types: pdf, jpg, png, doc, xlsx, csv, Max. file size: 128 MB, Max. files: 12.
    • Certifications

      To be eligible, the applicant must comply with all certifications. If you are not in compliance, please contact the Rising Tide Community Loan Fund.
    • I certify that the information provided in this Application and in all supporting documentation is true and accurate in all material respects and I further acknowledge and understand that knowingly making a false statement to obtain a grant under the COVID-19 Hospitality Industry Recover Program is punishable under penalty of perjury and fines pursuant to 18 Pa. C.S.A. § 4904 (relating to unsworn falsification to authorities).
    • Date signed
    • Please submit the completed application with required supporting documents to [email protected].
    • There will be a pause after pressing the submit button before the form is submitted. Please wait and do not hit the button multiple times! Most browsers will show a small circle spinning at the top of the browser (where the browser tabs are located) that indicates the browser is working. Thank you!
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