Application Form - Alternative Fuel Vehicle (Afv) Conversion Grants Draft - Ohio Environmental Protection Agency - 2017
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12Application Form: 2017 Alternative Fuel Vehicle (AFV) Conversion
Grants
For Office Use Only:
Application Number: __________________ Date Received: ____________________
Section 1. Contact Information for Applicant
Table 1-1. Please provide contact information for the applicant organization’s
Authorizing Agent (person who is authorized to sign the grant contract on behalf of the
organization). The applicant must be the legal entity who will own and register in Ohio
the vehicle(s) proposed for purchase with grant funds, or the legal entity who owns and
has already registered in Ohio the vehicle(s) proposed for conversion with grant funds.
a. Full name of Organization:
b. Federal Employer Identification
Number (EIN):
c. Street Address:
d. City:
e. State:
f. Zip Code:
g. County:
h. Name of person serving as Authorizing
Agent:
i. Authorizing Agent Phone Number:
j. Authorizing Agent E-mail Address:
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