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DocuSign Envelope ID:411EOFFO-1729-4846-85C5-DEDE0842FBBC <br /> Exhibit A <br /> CRANGE COUNTY <br /> NORTH CAROLINA <br /> Business Investment Grant Application <br /> Large Grant ($1,501 - $10,000) <br /> I <br /> BUSINESS INFORMATION' <br /> Business Name/DBA: Blip, Inc. <br /> 321 West Rosemary St. <br /> Address: Chapel Hill, NC 27516 <br /> Date business started: February 13, 2015 <br /> Number of employees: 2 founders <br /> Business telephone number: 919-602-6398 <br /> Email address: ricky @blipme.co <br /> ',Tax ID/Employment Identification Number <br /> (Primary bank Wells Fargo <br /> Accounting firm <br /> Attorney Wyrick Robbins Yates &Ponton <br /> BUSINESS FINANCIAL INFORMATION` <br /> Annual sales for the past 3 years(if applicable) $ $ $ <br /> Current business checking account balance $16,456.28 <br /> Balance(s) in other accounts $ <br /> Existing business debts(list on separate sheet) $ <br /> Amount of grant request <br /> ;(detail how funds will be used on separate page) <br /> Principal owner information Ricky McMahon <br /> I <br /> CHECKLIST. <br /> Application Will Not Be Accepted Unless Items Listed Below Are Included With Application. <br /> ❑ Business Financial Statements for past 3 years(if applicable) N/A <br /> ❑ Business Tax Returns for past 3 years(if applicable) N/A <br /> ❑ Existing Business Debts N/A <br /> ® Detailed written Business Plan (5-10 pages) or Power Point <br /> ® Detailed list of how funds will be used (1-2 pages) <br /> Thank you fo ur ort in completing the application form. Please si e proposal below. <br /> na Si natur atD e�' <br /> Si t a 9 g <br />