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T Post Office Box 301463 Montgomery, Alabama 36130-1463 (334) 271-7796 (334) 271-7950 FAX jwd adem.state.al.us CWSRF Loan Application Applicant: Project Name: Project Number: Notes: 1. This application must be submitted no later than May 1st. 2. Submit two complete copies, with attachments, to the address shown above. At least one copy should contain original signatures and be notarized as shown in the application. ADEM FORM 339m1 5/2014 Clean Water State Revolving Fund (CWSRF) Application.

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