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Moisad Security Assist

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General Info Form

Legal name of Organization*

D.B.A. (if applicable)

Mailing Address

Multi-line address

Country/Region*

Address*

Address - line 2

City*

Zip / Postal code*

Point of contact*

Position/Title*

FEIN*

UEI*

If you do not have a UEI, you must obtain one at www.sam.gov

Phone*

Email*

Name of official signatory for Organization*

Position/Title*

Phone*

Email*

Who will be managing the grant within the Organization?*

Position/Title*

Phone*

Email*

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