Closed Businesses Due to COVID-19

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* 1. Has your business been closed or drastically reduced hours due to COVID-19?

Yes

No

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* 2. How many employees are currently laid off or furloughed due to this closure?

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* 3. Would your staff benefit from canned foods, thermometers, hand sanitizer and other household goods?

Yes

No

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* 4. If we can deliver "shelter in place" supply kits, can we deliver them to your business and count on you to let your employees know these kits are available to them?

Yes

No

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* 5. Please fill in your contact information if you would like us to follow up with you.

Name

Business Name

Address

Email

Phone Number