Revised - July 2025
150 South Palm Avenue
Rialto, CA 92376
909-820-2525
www.yourrialto.gov
Organization’s Legal Name: _____________________________________________
Physical Address: _____________________________________________________
Mailing Address: ______________________________________________________ If different from physical
Contact Person #1: ____________________________________________________
Phone: _________________________________ Extension: ___________________
Email:_______________________________________________________________
Contact Person #2: ____________________________________________________
Phone: _________________________________ Extension: ___________________
Email:_______________________________________________________________
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