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* 1. Company Name and UBI#

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* 2. First and Last Name

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* 3. Address (Specify mailing or physical)

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* 4. City and/or Zip code

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* 5. Phone Number

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* 6. Email Address

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* 7. What is the primary business activity conducted by your company?

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* 8. Years in Business? 

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* 9. Number of employees? (Please specify between full time and part time)

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* 10. Number of employees retained after business downturn and closures as a result of COVID-19?

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* 11. What were your business revenues this time last year prior to the COVID-19 related issues?

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* 12. What are your business revenues after the COVID-19 related downturn and closures?

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* 13. Has your business been negatively impacted by COVID-19 related issues and if so how?

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* 14. What is your most immediate need to keep your business open for the next two months?

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* 15. Have you considered, or can we help you with, a new marketing strategy or change in your existing business model to help your business come out of the Stay at Home, Stay Healthy order?

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* 16. Do you need one-on-one confidential business counseling support from us at the EDC? If so, may we contact you?

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