In order to continue to serve our business community, we need to better understand your business' specific circumstances and how we can best assist.

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* 1. Company Name

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* 2. Phone Number

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* 3. Email Address

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* 4. Is your company currently being impacted by the COVID-19 pandemic? 

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* 5. If so, how?  (Please check all that apply.)

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* 6. How could your company be impacted by COVID-19 in the next 90 days? (Please check all that apply.)

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* 7. What kind of business do you own or represent?

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* 8. Is the business female owned?

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* 9. Does the business have culturally-specific ownership?

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* 10. Is the business veteran owned?

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* 11. Number of employees in February 2020?

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* 12. Number of employees today?

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* 13. Has your business received funding from any of the following grant or loan programs? (Please check all that apply.)

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* 14. What would be the most helpful support for your business? (Please check all that apply.)

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* 15. Is there any additional information that you would like us to know about your current situation and challenges?

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