COVID-19 Business Assistance Survey

Thank you for filling out this interest form and letting us know about the impact of COVID-19 on your business. Please continue to monitor your email – we will send information regarding the new loan and grant program for impacted small businesses, including application links, in the coming days.

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* 1. Contact Information

Full Name (First, Last)

Business Name

Business Address

Business Address 2

Business City/Town

Business State/Province

Business ZIP/Postal Code

Email Address

Phone Number

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* 2. Would you like to receive additional information on financial assistance related to Covid-19?

Yes

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* 3. Please describe your business loss due to COVID-19. Please describe any revenue decline, if applicable.

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* 4. Please estimate any revenue decline you've experienced as a result of COVID-19, if applicable.

<10%

10-20%

21-30%

31-40%

41-50%

51-60%

61-70%

71-80%

81-90%

91-100%

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* 5. Please estimate your monthly decrease in revenue you've experienced as a result of COVID-19, if applicable.

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* 6. How many employees do you have?

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* 7. What is your industry?

Professional Services

Retail - Online

Retail - Storefront

Personal Care (barber shop, nail salon, etc)

Restaurant / Food Industry

Other (please specify)

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* 8. Are you interested in other SBS services? Check all that apply.

Business Education Courses

Business Preparedness (general)

Commercial Lease Assistance

Financing Assistance

Resources for Women Entrepreneurs

Resources for Black Entrepreneurs

Understanding City Rules and Regulations for Businesses

Other (please specify)