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WeVax Business Participation Application

Questions marked with a * are required

Calaveras Public Health has received limited funds to provide incentives to community members who have done their part in the fight against COVID-19. Gift cards will be purchased from local businesses to incentivize those who have gotten vaccinated. You are invited to apply to participate in the incentive program. The application will take no more than 5 minutes to complete. Your participation is completely voluntary. Applying does not mean that you will be selected to participate in the program and depends on existing funds and the number of businesses who apply.

If you have questions at any time about the application, contact 209-754-6460 and ask for Haley or email Haley at hgraham@co.calaveras.ca.us. Thank you very much for your time and support.

Contact Information

Name of Business

Street Address

City

Zip Code

Contact Person (First & Last Name)

Email Address

Phone Number

Requirements to participate in the program include the following:

Must be able to provide pre-paid gift cards for your business
Gift cards cannot be used to purchase alcohol, tobacco, or cannabis products
Must be able to invoice Calaveras Public Health for gift cards
Business must be located in Calaveras County
Must provide a business license and a W-9
Must ensure gift cards cannot be duplicated
Must provide gift cards that do not have an expiration date or fee for using them
Must be able to deliver gift cards to the Calaveras Public Health office located at 700 Mountain Ranch Road, Suite C

Applying does not mean that you will be selected to participate in the program. Final participant selection depends on existing funds and the number of businesses that apply. Priority will be given to businesses who meet basic needs e.g. groceries, food, gas, etc.

I agree to the requirements of the program

I choose not to participate in the program