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

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* 2. Name of Business

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* 3. Business Physical Location

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* 4. Business Mailing Address

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* 5. Primary Contact Phone Number

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* 6. Primary Contact Email

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* 8. Is the business or organization currently 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?

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

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

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

Date
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.
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