How COVID-19 is Impacting Your Business

Question Title

* 1. Contact Information

Name

Company

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

Question Title

* 2. What is your industry?

Construction

Hospitality

Manufacturing

Logistics

Warehousing

Professional Services

Technology

Financial and Insurance Services

Staff Augmentation

Healthcare

Facilities Management

Other (please specify)

Question Title

* 3. Please describe any business lost due to COVID-19. Additionally, please describe any revenue decline, if applicable, as well as any other ways in which COVID-19 is affecting your business.

Question Title

* 4. What was your annual business revenue last year?

Under $1M

$1-10M

$10-50M

Over $50M

Question Title

* 5. How many employees do you have?

0 (Sole Proprietorship)

1-5

6-10

11-20

21-50

51-99

100+

Question Title

* 6. Please estimate any revenue decline you've experienced as a result of COVID-19, if applicable

<10%

10-20%

21-30%

31-40%

41-50%

51-60%

61-70%

71-80%

81-90%

91-100%

Question Title

* 7. Do you require additional capital to keep your business in operation?

Yes