Hurricane Ian Business Damage Assessment Form

Business Damage Assessment Form

Please fill out the form below so the Greater Fort Myers Chamber of Commerce can best assist you with your business needs during this time.

Question Title

* 1. Business Name:

Question Title

* 2. Business Address:

Street:

City:

State:

Zip Code:

County:

Question Title

* 3. Contact Details:

First Name:

Last Name:

Email Address:

Phone Number:

Question Title

* 4. Business Type: (Select all that apply)

Automotive

Business Support & Supplies

Computers & Electronics

Construction & Contractors

Education

Entertainment

Food & Dining

Health & Medicine

Home & Garden

Legal & Financial

Manufacturing

Retail

Personal Care

Real Estate

Travel & Tourism

Other

Question Title

* 5. Are you currently open for business?

Yes

Alternate Location/Alternate Hours

Question Title

* 6. If you selected Alternate Location/Alternate Hours please answer below:

Alternate Location:

Alternate Hours:

Question Title

* 7. Did your business location suffer damage?

Yes

Unsure

Question Title

* 8. Type of damage?

Physical

Economic/Lost Revenue

Question Title

* 9. Physical Damage:

If your business is not usable, what type of space do you require?

Square Feet needed:

Type of access needed:

Estimated length of time needed (approximate number of days):

Question Title

* 10. Economic Damage: Did you lose business due to this emergency/disaster?

Yes

Unsure

Question Title

* 11. Economic Damage: Do you have business interruption insurance?

Yes

Unsure

Question Title

* 12. How many employees (full time and part time) do you currently have?

Question Title

* 13. Have you or will you lay off employees as a result of this emergency/disaster?

Yes

Question Title

* 14. Do you sell food products?

Yes

Question Title

* 15. Have you registered for disaster assistance with FEMA?

Yes

Question Title

* 16. Other key factors hindering business operations: (select all that apply)

Debris Removal

Insurance Settlement

Product Supply

Short Term Capital

Construction/Contractor

Water Damage

Long Term Capital

Training/Personnel

Employee Transportation

Customer Base

Financial/Business Loans

Physical Access to Business

Question Title

* 17. Would you like to be contacted with more information about business relief services and programs?

Yes

Question Title

* 18. If you have not registered with FEMA, please visit www.disasterassistance.gov

I acknowledge

Question Title

* 19. Check the types of assistance your business in interested in receiving:

FL Small Business Emergency Bridge Loan:
A short-term, interest-free loans up to $50,000 available to small business owners who have between 2 to 100 employees, have been in operation for at least one full year and have experienced physical or economic damage.
For more information, please visit: https://deosera.force.com/RebuildFloridaBusinessLoanFund/s/

SBA Physical Disaster Loans:
Loans are available to qualified applicant businesses of any size for uninsured losses up to $2 million to repair or replace business property to pre-disaster conditions. Loans may be used to replace or repair real estate, equipment, fixtures and inventory and leasehold improvements.
For more information, please visit: https://disasterloanassistance.sba.gov/ela/s/article/Business-Physical-Disaster-Loans

SBA Economic Injury Loans:
Loans up to $2 million are available for small businesses that sustain economic injury as a direct result of a disaster. These working capital loans are made to businesses without credit available elsewhere to help pay ordinary and necessary operating expenses that would have been payable barring the disaster.
For more information, please visit: https://disasterloanassistance.sba.gov/ela/s/article/Economic-Injury-Disaster-Loans

Small Business Development Center Business Counseling:
Certified business analysts will provide general business counseling to help access traditional SBA loans.
For more information and locations, please visit: https://fsbdcswfl.org/