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* 1. How has your business been impacted by this COVID crisis?  (Choose answer that best fits)

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* 2. The support we could most use right now is..  (Check all that apply)

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* 3. What industry are you in?  (Choose best fit)

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* 4. How many Fifth Ward residents..

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* 5. How long have you been operating?  (This info will help us seek grants for the community)

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* 6. Please provide the following optional contact information:

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