BIODIESEL PRODUCTION GRANT

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In order to qualify for this program, all of the following must be true: (The application will appear once you've met all of the criteria below) Is the facility's legal business address in the state of Connecticut? Yes No Is the facility registered with the Connecticut Secretary of the State? Yes No Is the facility actively engaged in the production of biodiesel in Connecticut during the time of application for, or before the insurance of, grant funds? Yes No Is the facility designed, built and/or installed to produce biodiesel? Yes No Is the facility producing biodiesel for commercial purposes? Yes No

Application for Eligibility BIODIESEL PRODUCTION GRANT This form to be used only at initial application

Applicant name:

Legal business address:

Street/PO Box Number:   Street Name:   Town:   ZIP Code:

Production facility name:

Production facility location:

Street Number:   Street Name:   Town:   ZIP Code:

Connecticut Secretary Of State Identification Number:

Number of Connecticut residents employed in the last month (FTE):

Description of existing facility operations:   In your description, please include estimates for the following: Capacity for biodiesel production Type of business Types of products produced Type of technology used for biodiesel production, and Expected market and market targets.

I CERTIFY UNDER PENALTY OF LAW, BASED ON INFORMATION AND BELIEF FORMED AFTER REASONABLE INQUIRY, THE STATEMENTS AND INFORMATION CONTAINED IN THESE DOCUMENTS ARE TRUE, ACCURATE AND COMPLETE.

Name (Typed):

By typing your name here you are electronically signing this application.

Title:

Date:

Applicant shall not in any way rely on this program, the State of Connecticut, or CCAT for funding. CCAT is in no way responsible should funding not be made available by the State of Connecticut or other government source.