Marketing Support Grant

Vendor Information Form

Complete one copy of this sheet for each marketing vendor beyond the primary vendor listed on the main application. Fill out as many sheets as needed.

Business Name (Applicant)

Grant Application Reference # (if assigned)

Vendor Sheet # of Total Vendor Sheets

VENDOR INFORMATION

Vendor / Provider Business Name

Is this vendor Staunton-based? (Yes / No)

Vendor Street Address

Vendor Phone

Vendor Email / Website

Vendor Point of Contact

Total Cost for this Vendor ($)

SERVICES & COST

Describe the marketing services to be provided by this vendor:

Total Cost for this Vendor ($)

Anticipated Service Dates (Start – End)

Reimbursement Rate for this Vendor:

Staunton-based vendor — 100% reimbursement rate applies

Out-of-area vendor — 50% reimbursement rate applies

REQUIRED DOCUMENTATION FOR THIS VENDOR

Attach the following for this vendor:

Vendor quote or proposal

Drop files here or

Max. file size: 2 GB.

Signed vendor contract or agreement (if available at time of application)

Drop files here or

Max. file size: 2 GB.

Sample work or portfolio (if applicable)

Drop files here or

Max. file size: 2 GB.

AUTHORIZED SIGNATURE

Must match main application.

Printed Name

Title / Position

Date