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* 1. Business Owners Name

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* 2. Phone Number

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* 3. Email Address

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* 4. Which designated project area is your business located in?

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* 5. Did Hurricane Michael damage your building?

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* 6. Does your business have exterior damage from Hurricane Michael that has not been repaired?

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* 7. Is you business controlled by persons who are eligible to work in the U.S.?

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* 8. Was you business established on or before October 10, 2018?

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* 9. Is your business appropriately registered with the State of Florida?

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* 10. Did you employ at least two (2) full-time employees prior to October 10, 2018?

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* 11. Do you currently employ at least two (2) full-time employees? 

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* 12. Name of Business

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* 13. Business Address

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* 14. FEIN #

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* 15. Which repairs/improvements are you interested in applying for?

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* 16. Additional Comments:

Please send the following documents to hometown@pcgov.org
  • State Certificate of Status
  • State/local tax registration or Certificate of Exemption
  • State or professional license if applicable
  • Pictures of Hurricane Michael damage
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