WebGrants - Texas Access to Justice Foundation

Personal Information

Name:*


Salutation	First Name	Middle Name	Last Name

Email:*

Confirm Email*

Phone:*


Phone	Ext.

Fax:

Select Appropriate Category*

Organization Information

Organization Type:

Organization Website:

Mailing Address:*


City	State/Province	Zip Code:

Phone:*


	Extension

Fax:

Physical Address:*


	City:	State	Zip Code:	County:

Executive Director Information

Executive Director Name:

Direct Line (Phone):


	Extension

Email:

Board Chair Information

Board Chair Name:

Direct Line (Phone):


	Extension

Email:

Chair's Mailing Address:

City:

State:

Zip:

Banking Information

Organization Grantees Only: Only enter banking information if the Foundation grants funds to your organization.

Bank Name:

Bank Address

Bank Account Number:

Routing Number:

The comptroller assigns your vendor ID number for all funds distributed by the State. Only include a vendor ID number if you have a BCLS and/or a CVCLS grant.

Vendor ID Number:

Verify Submission