Your InformationName(Required) First Last Business Name(Required)Property Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Mailing Address (If Different) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneEmail(Required) Project InformationDescription of Work Performed(Required)(Please provide a brief description of the graffiti removal and/or preventative measures taken.)Preventative Measures Installed(Required)Total Cost of the Project(Required)Amount Requested (50% of total cost, up to $1,500)(Required)Supporting DocumentsBefore Photos of the affected area(s)(Required) Drop files here or Select files Accepted file types: pdf, doc, jpg, mp4, Max. file size: 10 MB, Max. files: 5. Upload up to 5 supported files: PDF, document, image, or videoReceipts or Invoices for the work completed.(Required) Drop files here or Select files Accepted file types: pdf, doc, jpg, Max. file size: 10 MB, Max. files: 5. Upload up to 5 supported files: PDF, document, or image.Proof that the City of Whittier will not cover the cost of graffiti removal (if applicable). Drop files here or Select files Max. file size: 10 MB, Max. files: 1. Upload 1 supported filePolice Crime Report NumberBy completing this form, I acknowledge that I have completed the work as described above and that all information provided is accurate to the best of my knowledge. I also acknowledge that all work complies with city regulations and codes, and guidelines as outlined in the full Fresh Facade Fund Pilot Program. Yes No 43958