COVID 19 Assistance

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* 1. Business Name

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* 2. Email Address

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* 3. Type of business (products/services)

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* 4. Are you a franchise?

Yes

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* 5. How has COVID 19 impacted your business so far?

Sales

Supply Chain

Customer Demand

Employee Availability

Other (please specify)

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* 6. Do you have employees?

I am self-employed, I am the only employee

I am the business owner, I have employees

I am self-employed, I have employees

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* 7. Do you plan to lay off employees?

Yes, we have already laid off some employees

Yes, we will be laying off some employees

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* 8. What are your immediate needs?

Insurance Advice

Cash Flow

Lack of available employees

Knowing what grants and financial support options are available

Property tax relief

Utilities relief

Rent or mortgage relief

Other (please specify)

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* 9. What do you anticipate your needs will be in the next 1-2 weeks?

Insurance Advice

Cash Flow

Lack of available employees

Knowing what grants and financial support options are available

Property tax relief

Utilities relief

Rent or mortgage relief

Other (please specify)

COVID 19 Assistance

Question Title

* 1. Business Name

Question Title

* 2. Email Address

Question Title

* 3. Type of business (products/services)

Question Title

* 4. Are you a franchise?

Question Title

* 5. How has COVID 19 impacted your business so far?

Question Title

* 6. Do you have employees?

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* 7. Do you plan to lay off employees?

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* 8. What are your immediate needs?

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* 9. What do you anticipate your needs will be in the next 1-2 weeks?

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* 10. Anything else you'd like to add?