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CITY OF CENTERVILLE <br />REVOLVING LOAN PROGRAM <br />GRANT APPLICATION <br />Business Owner(s): <br />Business Name: <br />Business Address: <br />Phone: <br />Qualifying Rehabilitation: <br />Cost of Rehabilitation: <br />Facade Improvement(s): <br />Facade Improvement Cost: <br />Documentation on File: <br />Grant Amount: <br />I hereby acknowledge that the facade work and/or materials referenced above have <br />been completed and paid for at the above address. <br />Signature of Owner <br />Date <br />Signature of Executive Director EDA Authorizing Grant Date <br />20 <br />