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2. Agency Name*
4. Address*
6. City*
7. State*
8. Zip Code*
10. Amount Requested*
12. Authorized Agent Name/Title*
13. Authorized Agent Telephone:
15. Authorized Agent E-mail Address*
17. Contact Name/Title*
18. Contact Telephone*
20. Contact E-mail Address*
24. Please answer the following questions.
26. What project or event will these funds service, and what is the date or date range of the events or services provided?*
28. How is the funding to be used?*
30. How does funding this project/event benefit the citizens of the Town of Indian Trail?*
32. Is this Agency subject to independent auditor or review annually?*

    1. Yes
    2. No
34. Required Document:

    Please provide the following documentation: 503(c) Form and W-9 with this application.

36. Name of Authorized Person listed above*
    This will be used as your signature.
37. Date*
39. Contact:
    Town Clerk, Kathy Queen, at 704-821-5401, if needed
Leave This Blank:


41. 1. Receive an email copy of this form.
42. Email address

    This field is not part of the form submission.

43. Submit

* indicates a required field