2025 Bridge Bucks Application Step 1 of 4 25% To successfully submit your application for the 2025 MCRC Bridge Bucks Program, you must provide all requested information and upload all requested documentation. We encourage interested business to attend a live, online information session prior to submitting an application. To attend an upcoming session, please register here. We highly recommend that you download a copy of the application instructions, familiarize yourself with them, and prepare your information and narrative responses beforehand. To be considered for the program, you must complete the application thoroughly and submit documentation supporting your business’s eligibility. Please remove all passwords from PDF documents before uploading them to the application. If passwords are on any documents, we cannot open them, and your application will be disqualified. You may save and return to the application anytime before submitting. If you have any questions or trouble completing the application, please reach out to the MCRC Administrator, Rebecca Mead, at rebecca@middlesexchamber.com. Business InformationBusiness Name(Required)Name of person completing this application(Required)Email(Required) Role at businessI am authorized to complete this application on behalf of this business.(Required) Yes No Date Business Started(Required) Month Day Year Business Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Business Website(Required) Number of years the business has been in current location(Required)Federal Tax ID Number(Required)Majority Business Ownership(Required) Woman-owned Minority-owned Veteran-owned Disabled-owned None of the above Business Formation(Required)Sole-ProprietorLLCCorporationS-CorpPartnershipNonprofit Organization - 501(c)3Name and city of all members of LLC.(Required)NameCity / Town Add RemoveName and city of all officers and directors of corporation.(Required)NameCity / Town Add RemoveName and city of all business stakeholders.(Required)NameCity / Town Add RemoveName and city of all partners, including proportionate share of all partners.(Required)NamePatnership shareCity / Town Add RemoveUpload IRS Determination Letter (nonprofit organizations only)(Required)Accepted file types: pdf, Max. file size: 300 MB.Upload the Letter of Good Standing from the Department of Revenue Services(Required)Accepted file types: pdf, Max. file size: 300 MB.Please describe your business. Please be as detailed as possible within the allocated 500 words.(Required)Employment InformationHow many employees were on your payroll as of the following dates? Please note, 1099-contractors are not considered employees. As of today's application date:(Required)Full Time EmployeesPart Time EmployeesAs of December 31, 2024:(Required)Full Time EmployeesPart Time EmployeesIf you anticipate adding to staff within the next year, please indicate the number of full and part time employees:(Required)Full Time EmployeesPart Time EmployeesIf none, so state.IRS Form 941Accepted file types: pdf, Max. file size: 300 MB.Please upload IRS form 941 for 2024 Q4. If your business is a Sole Proprietorship or LLC with no employees other than the owner/single member, this does not apply to you. All entities with employees are required to submit this form. DOT ImpactsPlease share how the DOT construction projects (Swing Bridge and Route 154 Traffic Circles) are affecting/have affected your business.(Required)In the past three years, have you received any funding/assistance to help mitigate the DOT impacts?(Required) Yes No If yes, please provide details of the funding.(Required)Use & Promotion of Bridge BucksPlease describe how your business plans to promote and use Bridge Bucks.(Required) Section BreakCertification(Required) By submitting this application, you represent and certify to the best of your knowledge and belief that the information you have provided and the attachments hereto are true and complete and accurately describe your participation in the Bridge Bucks Program. You agree to promptly inform MCRC of any changes that may occur. You certify that the applicant business is in good standing with the town in which it is located, and is compliant with the Connecticut Department of Labor Office of Unemployment Assistance and all applicable state and federal employment laws and regulations, including but not limited to minimum wages, unemployment insurance, workers’ compensation, and child labor. You also agree, should you receive the Bridge Bucks coupons, to use the coupons per the agreement and notify MCRC promptly should circumstances change.Name(Required)Phone(Required)Please provide the best number to reach you should the MCRC review subcommittee have questions. Email(Required) Signature(Required)
