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#PayItForward St Pete Registration
1.
Has your business been impacted by the wave of shutdowns and slowdowns caused by government efforts to contain the Coronavirus pandemic?
Yes
No
2.
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 since March 16, 2020) (100 words max)
3.
Do you own the shop where you perform services?
Yes
No
4.
If you are the BUSINESS OWNER, please answer the following questions. IF NOT, please skip to the next question.
Your name (owner)
Business name
No. employees (on W2)
No. contractors (on W9)
No. contractors (other)
Addreess (street, city, state, zip)
Email
Cell phone
Business website (if applicable)
5.
If you are NOT THE OWNER of the place where you perform services, please answer the following questions.
Your name
Name of business where you work
Address of business where you work
Cell phone of business owner
Your email
Your cell phone
6.
What types of help may you need to get through this crisis period? (please check all that apply)
Accessing available emergency loans
Accessing available emergency unemployment benefits (for yourself or your workers)
Creating a new product/service line
Evolving your business model/creating a new business model for this new environment
Other (please specify)
7.
Do you offer mobile, in-home or in-office services?
Yes
No, but willing to
No, unable to at this time
