10% Guaranteed Grant

ParticipACTION / GreenGym grant request form

This form must be signed and returned to GreenGym two (2) weeks before placing the purchase order. If your purchase will be tendered this application must returned to GreenGym three (3) weeks before the tender deadline.

The grant is only available for Canadian Municipalities, public organizations and not for profit organizations. Buyers who plan to purchase GreenGym equipment several times a year are eligible to receive the grant for each one of their purchases. The grant will cover 10% of the equipment purchase only. The grant will not cover shipping or installation. The grant will be paid by ParticipACTION only after the final payment has been received by GreenGym. Please fax the application to GreenGym ParticipACTION only after the final payment has been received by GreenGym. Please fax the application to GreenGym Fax: 902-469-0373

Name of organization:

Form of organization: Federal Provincial Municipal Organization type: Recreation Senior Youth Community Health

Not for profit: Y N Other

What is the purpose of the organization:

Contact person: First Last Title

Phone Ext Fax Alternate #

Website E-mail

Address Suite City/Town

Province Postal code Organization GST/HST #

Have you ever requested this grant before? Y N If yes, when?

Are you applying for another source of funding? Y N If yes, which one?

How many fitness units do you plan to purchase? When? /

Method of purchase:

Direct purchase from GreenGym RFP RFQ Tender If tender when is the deadline? / /

I hereby certify that the above are true and acurate and that i’m authorized to sign this application behalf of the applying organization.

Executive Director or Authorized Officer Signature Date

M

M M

M Y YD D 2

2 0

0

Y Y