224-225 Account Application Form

County Law 224/225 Account Application

Use this form to request a secure Document Portal account.
Date

MonthDayYear
DateHourMinutesAM/PM Option
Name of Organization*
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Representing Agent*

First NameLast Name
Phone Number*

Area CodePhone Number
E-mail*
Which grant are you applying for?

Community ServiceCultural Arts Grant
I am replacing a previously registered agent*

YesNo
Enter the name of the previously registered agent*
Short Description of Services*
Anti-Spam Verification *

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County Law 224/225 Account Application