Small Business Support for Urban Brew Community

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* 1. Your full name

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* 2. Is your Urban Brew account in your name? (type yes, or if not please write the account holders name)

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* 3. What is your Business name and Industry (optional)

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* 4. What is your email?

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* 5. What is your phone number?

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* 6. How many staff do you have?

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* 7. How close are you to permanently closing your business (1 low risk – 5 high risk)

1

5

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 8. What are your top 1-3 challenges?

1

2

3

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* 9. What are your top 1-3 expenses / costs?

1

2

3

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* 10. Anything else I should know?