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Applicant Information

Title II Compliance
In accordance with the requirements of Title II of the Americans with Disabilities Act (“ADA”) of 1990, the Fair Employment & Housing Act (“FEHA”), the Rehabilitation Act of 1973 (as amended), Government Code section 11135 and other applicable codes, the City of Modesto (“City”) will not discriminate against individuals on the basis of disability in the City’s services, programs, or activities. For more information, please visit the City of Modesto website.
First Name*
Last Name*
Email Address*
Street Address*
City*
State*
Zip Code*
Daytime Phone*
Cell Phone*
Fax Number*
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Business Name
Business Description
Business Street Address*
City*
State*
Zip Code*
Has this business had another physical address in the past?
1. Yes
2. No
Previous Street Address (If Any)
City
State
Zip Code
Weekly Operating Hours (days and times)*
Previous Weekly Operating Hours (If Any)
Weekly Labor Hours*
Previous Weekly Labor Hours (If Any)*
Date Business Hours Expanded*
Date Business Hours Expanded
Move in Date (current location)*
Move in Date (current location)
Modesto Business License Effective Date*
Modesto Business License Effective Date
Business License Number*
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Draft Business Plan
Upload a copy of your draft business plan.
Approved Business License
Upload a copy of your Approved Business License.
Letter of Intent to Lease
Upload your Letter of Intent to Lease for your business location.
Additional Document Delivery Options
You will need to send us a signed W-9 form to complete your application. Due to the sensitivity of information collected on the form, you will need to choose an option below to submit this document.
1. Fax to 209-491-5798
2. Mail to 1010 10th Street, Suite 3300, Modesto, CA 95354
3. Bring in to to 1010 10th Street, Suite 3300, Modesto, CA 95354
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Application Submission Acknowledgement
1. I understand that by submitting this application, I am not guaranteed any incentive offering.
Business Owner (Type Name)
By typing your name in this box, you are electronically certifying that all information you are submitting to the City of Modesto for consideration is true to the best of your ability and knowledge.
Date
Date

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