*1.Thank you for filling out this brief questionnaire. The Pasadena Chamber of Commerce Foundation, in consultation with the Altadena Chamber of Commerce, will be granting funding of between $500 and $2,500 to locally owned Altadena small businesses impacted by the Eaton fire.

To be eligible, your small business must be (or have been) located in the 91001 Zip Code.

Please answer these few questions so we can evaluate your needs and determine eligibility.

Unfortunately, we have limited funds and will not be able to grant funds to everyone who fills out the application.

We are very grateful to SoCalGas for providing funding for these grants for local Altadena small businesses.

What is the name of your business?(Required.)

*2.What is/was the address of your business (in Altadena)(Required.)

3.Do you own the property where your business is/was located?

Yes

No

*4.What is the nature of your business? What product or service do/did you provide?(Required.)

*5.What is your name(Required.)

*6.What is your email address(Required.)

*7.What is your cell phone number(Required.)

8.What is your website address.url for your business?

*9.What is the extent of damage to your business from the winds, Eaton fire or its aftermath?(Required.)

Destroyed

Damaged

Unable to reopen at this time

Reopened at my original location

Relocated and reopened

Equipment/tools lost/destroyed

10.What are your future business plans?

I am reopened in a new location temporarily (but want to return to Altadena)

I am reopened in a new permanent location

I am seeking a location to reopen temporarily (before returning to Altadena)

I am seeking a new permanent location to reopen

Other (please specify)

*11.We will be providing grants of $500 to $2,500 to help fire impacted Altadena businesses to reopen. How much are you requesting?(Required.)

*12.What will the money be used for? Please be as specific as possible. (For example, I need $2000 to set up a phone system and buy a computer.)(Required.)

*13.Is this a reimbursement for expenses already incurred?(Required.)

Yes

No

14.Is there anything else you would like to add?