ALX B2B Business Association Grant Program 

Financial Disbursement Form

ALX B2B Business Association Grant Program recipients should only complete this form. The purpose of this form is to collect bank account information to facilitate the transfer of funds from the Alexandria Economic Development Partnership (AEDP) to grant recipients. Please only complete this form once.

To receive grant funds, all business associations must submit an executed Performance Agreement separately. All grant awards and grant amounts have been previously approved and are final. Funds will be disbursed to the recipients via direct deposit using the information provided through this form. Grant awards will be disbursed in one installment.

Data collected through this form will only be shared with or viewed by individuals directly involved with the administration of grant awards. Business associations should not submit their bank account information to AEDP by any other means, including email.

AEDP anticipates the disbursement of funds to take approximately 2-3 weeks from the submission date of this form by the grant recipient. Any questions about this form should be directed to Senay Gebremedhin, AEDP Economic Recovery Manager, by phone or email at 703-652-5347 or gebremedhin@alexandriaecon.org.

I certify that I have read and understand and am authorized to complete and submit this application on behalf of the ALX B2B Business Association Grant recipient. I verify that the statements herein are true, accurate, and complete. I acknowledge that false and inaccurate statements made on the application are grounds for immediate rejection of the application.