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ESTIMATED BUSINESS IMPACTS FROM COVID-19

The Agency of Commerce and Community Development is seeking to understand and document the impacts of COVID-19 on Vermont businesses. Accurate responses to the questions below will assist the Agency as we continue to assess and respond to unfolding events.

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* 1. Contact Information

First Name:

Last Name:

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* 2. Name of Business:

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* 3. Business Physical Location:

City

County

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* 4. Business Mailing Address:

Street:

City:

State:

Zip:

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* 5. Primary Contact Phone Number:

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* 6. Primary Contact Email:

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* 7. Type of business (Choose one):

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* 8. Is the business or organization currently open? Choose one:

Fully Open

Partially Open

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* 9. How many people did you employ prior to the disaster?

Please list number:

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* 10. How many people do you employ now after disaster impacts?

Please list a number only:

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* 11. What type of adverse economic effects the disaster had on your business (Check all that apply):

Closure of Business

Partial Closure of Business

Reduction in Workforce

Supply Chain Disruption

Loss of Sales During Disaster (Event Cancellations)

Loss of Sales During Disaster (Lodging Cancellations)

Loss of Sales During Disaster (Retail Sales)

Loss of Sales During Disaster (Food and Beverage Sales)

Loss of Sales During Disaster (Service Cancellations)

Loss of Sales During Disaster (Production or Manufacturing)

Loss of Future Sales

Loss of Inventory

Loss of Cash Flow Reserves

Other (please specify)

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* 12. What is the total estimated loss of business revenue?

Estimated Monthly Revenue Loss ($) enter number only:

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* 13. What kind of targeted assistance might be most impactful to the continuity of your operations in the next 30-60 days?

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* 14. What kind of targeted assistance might be most impactful to the continuity of your operations in the next 60+ days?

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* 15. Are you aware of the financial assistance programs offered by the US Small Business Administration (SBA) to businesses that have been impacted by COVID-19?

Yes

If no, you can learn more about these programs here.

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* 16. If yes, do you intend to use any of the programs to help your business recover?

Yes

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* 17. If yes, which program have you applied for or intend to apply for?

Paycheck Protection Program

Economic Injury Disaster Loan

Thank you for providing information to the Vermont Agency of Commerce and Community Development. We know these are difficult times for many Vermont businesses and we stand ready to provide additional guidance as resources and response programs become available. Please stay informed by signing up for our COVID-19 Economic and Community Response Newsletter if you haven’t already done so. If you have further questions please email: commerce.covid19@vermont.gov.

*NOTE: The State may share information with organizations outside state government that may be able to provide additional assistance.