Organization Name *
Organization Main E-mail *
Organization Purpose *
CEO First Name *
CEO Last Name *
CEO Phone *
CEO Address Line 1 *
CEO Address Line 2
CEO City *
CEO State *
CEO Zipcode *
Non-Profit *NoYes
Organization Website *
Territory *Cowboy CountryIndian TerritoryLas Vegas TerritoryNevada Silver TrailsPony Express TerritoryReno-Tahoe TerritoryState-wide
Corporate ID (Nevada Secretary of State | Find ID)
Federal Tax ID (IRS Issued Tax ID | Find ID)
Are you a registered Nevada Vendor? *(Grant payment cannot be made until you are a registered vendor.)NoYes
Date organization was formed *
Annual Budget (optional, not required)
Phone *
Fax
Address Line 1 *
Address Line 2 (optional)
City *
State *NevadaAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
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