Outdoor Dining Street Closure Program Request Form

Mayor Brandon M. Scott’s Outdoor Dining and Street Closure Program

Small Business Rebate Payment Submission Form
The City of Baltimore's Outdoor Dining and Street Closure Program will provide grants to rebate permit fees collected by City or State agencies for outdoor table service, up to the amount of $800.

Online Submission
- Complete online form
- Attached supporting documentation
  - Vendor W-9 ( blank form )
  - Applicable fee invoices and proof of payment
  - Outdoor Dining and Street Closure Program Approval Email
  - ACH/Direct Deposit Authorization Form ( blank form )
- Sign form
- Click submit
Comments and/or questions
Please contact Daniel Ramos, Deputy Chief Administrative Officer,
at daniel.ramos@baltimorecity.gov
Today's Date *

Month Day Year
Date
Company *
Contact Name *

First Name Last Name
Phone Number *

Area Code Phone Number
Email *
example@example.com
Company Mailing Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Grant Payment

If approved, grant payments will be sent via ACH (Electronic Payment) or check. An ACH authorization form and a copy of a voided check is needed to process an electronic payment.
Requested Payment Amount *
Type of Payment *

ACH (Electronic Payment) - Preferred Check
Check Remittance Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Supporting Documentation

Please attach your company's W-9, applicable permit fee invoices and proof of payment
Upload IRS-W9 Form *

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Cancel of
Applicable permit fee invoices and proof of payment *

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Cancel of
ACH/Direct Deposit Authorization Form

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Cancel of
Applicant Signature

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Mayor Brandon M. Scott’s Outdoor Dining and Street Closure Program

Online Submission

Grant Payment

Supporting Documentation