New Mexico FUNDIT Application

Applicant Information

Legal Company/Organization Name

Contact First Name

Contact Last Name

Title

Phone Number

Email Address

Organization Address

City

State

Zip

Project Information

Project Description

Project Owner (if different then contact above)

Project Location (if different then address above)

Project Purpose

Project Type

NewReplace/ExistingRenovate/RepairOther

Total Project Estimated Cost

Enter dollar amount only

Total Amount Secured So Far

Enter dollar amount only

Total Gap

Enter dollar amount only

Anticipated Start Date

Anticipated End Date

Please describe the issue or problem that requires funding?

What funding sources do you have in place? Please explain a brief summary of the major cost components within the total project cost.

Additional Information

Affirmation

The checkbox and fields below affirms that the information in this Eligibility Questionnaire is true and accurate to the best of their knowledge and belief.

Applicants Authorization

I certify that the information in this form is true and accurate to the best of my knowledge.

Applicants Name and Title