Thank you for filling out this Business Assistance Resources Needs Survey form and letting us know about the impact of COVID-19 on your business. The information gathered will help us better understand your current and anticipated business challenges.  Please continue to monitor your email – we will send information regarding business assistance resources in the coming days.

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* 1. Contact Information

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* 2. Phone Cell

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* 3. Office Fax

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* 4. Preferred Contact Method

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* 5. Would you like to receive additional information on business resource assistance related to COVID-19?

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* 6. Please describe your business loss due to COVID-19

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* 7. Please estimate any CURRENT revenue decline your business has experienced as a result of COVID-19

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* 8. Please estimate any ANTICIPATED revenue decline to your business as a result of COVID-19

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* 9. How many employees (including yourself) does your business have?

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* 10. Does your business offer paid sick leave?

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* 11. If so, how is it calculated?

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* 12. How many employees are currently eligible for paid sick leave?

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* 13. Do you have business disruption insurance?

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* 14. What is your business industry?

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* 15. What COVID-19 business assistance resources are you aware of?

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* 16. Have you accessed any COVID-19 business assistance resources?

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* 17. If yes, what service(s) and what was your experience?

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* 18. In your own words, tell us what you need to help your business sustain during this social and economic crisis:

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