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* 1. Has your business been impacted by the wave of shutdowns and slowdowns caused by government efforts to contain the coronavirus pandemic?

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* 2. Briefly, tell us how? (50 words max)

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* 3. If you have lost customers and revenue, please briefly describe the loss in numbers (e.g., number of typical customers pre-corona and loss of customers this week OR typical revenue per week versus post-corona revenue). (100 words max)

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* 4. Your Contact Information



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