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* 1. Name of Business

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* 2. Town(s) where business is located

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* 3. Type of business

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* 4. Are you offering the following options (select all that apply)

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* 5. What are your concerns about reopening? (select all that apply)

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* 6. When do you expect to be back at 100% staffing levels?

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* 7. What restrictions would you like to see lifted/loosened in Phase III? (select all that apply)

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* 8. Do you want to be able to continue to sell alcohol to go?

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* 9. Other comments

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