ESTIMATED BUSINESS IMPACTS FROM COVID-19

The information collected in this survey is critical in helping us to advocate for aid for the region's businesses.

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* 1. Contact Information

First Name

Last Name

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* 2. Name of Business

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* 3. Business Physical Location

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* 4. Business Mailing Address

Street

City

State

Zip

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* 5. Primary Contact Phone Number

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* 6. Primary Contact Email

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* 7. Type of Business

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* 8. Is the business or organization currently open?

Fully Open

Partially Open

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* 9. How many people did you employ prior to the disaster?

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* 10. How many people do you employ now after disaster impacts?

Please list number:

Date of workforce reduction:

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* 11. What type of adverse economic effects the disaster had on your business? (Check all that apply)

Closure of Business

Partial Closure of Business

Reduction in Workforce

Supply Chain Disruption

Loss of Sales During Disaster (Event Cancellations)

Loss of Sales During Disaster (Lodging Cancellations)

Loss of Sales During Disaster (Retail Sales)

Loss of Sales During Disaster (Food and Beverage Sales)

Loss of Sales During Disaster (Service Cancellations)

Loss of Sales During Disaster (Production or Manufacturing)

Loss of Futures Sales

Loss of Inventory

Loss of Cash Flow Reserves

Other (please specify)

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* 12. What is the total estimated loss of business revenue?

Estimated Loss ($)

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* 13. When did the loss do to this disaster begin? If it has ended, please identify the duration.

Date / Time Loss Began

Date

Date / Time Loss Ended

Date

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* 14. What kind of targeted assistance might be most impactful to the continuity of your operations in the next 30-60 days?

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* 15. What kind of targeted assistance might be most impactful to the continuity of your operations in the next 60+ days?

Thank you for providing information to the Brattleboro Development Credit Corporation. We know these are difficult times for many Windham Region businesses and we stand ready to provide additional guidance as resources and response programs become available.