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Hurricane Ian Business Damage Assessment Form
Business Damage Assessment Form
Please fill out the form below so the Greater Fort Myers Chamber of Commerce can best assist you with your business needs during this time.
OK
1.
Business Name:
2.
Business Address:
Street:
City:
State:
Zip Code:
County:
3.
Contact Details:
First Name:
Last Name:
Email Address:
Phone Number:
4.
Business Type: (Select all that apply)
Automotive
Business Support & Supplies
Computers & Electronics
Construction & Contractors
Education
Entertainment
Food & Dining
Health & Medicine
Home & Garden
Legal & Financial
Manufacturing
Retail
Personal Care
Real Estate
Travel & Tourism
Other
5.
Are you currently open for business?
Yes
No
Alternate Location/Alternate Hours
6.
If you selected Alternate Location/Alternate Hours please answer below:
Alternate Location:
Alternate Hours:
7.
Did your business location suffer damage?
Yes
No
Unsure
8.
Type of damage?
Physical
Economic/Lost Revenue
9.
Physical Damage:
If your business is not usable, what type of space do you require?
Square Feet needed:
Type of access needed:
Estimated length of time needed (approximate number of days):
10.
Economic Damage: Did you lose business due to this emergency/disaster?
Yes
No
Unsure
11.
Economic Damage: Do you have business interruption insurance?
Yes
No
Unsure
12.
How many employees (full time and part time) do you currently have?
13.
Have you or will you lay off employees as a result of this emergency/disaster?
Yes
No
14.
Do you sell food products?
Yes
No
15.
Have you registered for disaster assistance with FEMA?
Yes
No
16.
Other key factors hindering business operations: (select all that apply)
Debris Removal
Insurance Settlement
Product Supply
Short Term Capital
Construction/Contractor
Water Damage
Long Term Capital
Training/Personnel
Employee Transportation
Customer Base
Financial/Business Loans
Physical Access to Business
17.
Would you like to be contacted with more information about business relief services and programs?
Yes
No
18.
If you have not registered with FEMA, please visit www.disasterassistance.gov
I acknowledge
19.
Check the types of assistance your business in interested in receiving:
FL Small Business Emergency Bridge Loan:
A short-term, interest-free loans up to $50,000 available to small business owners who have between 2 to 100 employees, have been in operation for at least one full year and have experienced physical or economic damage.
For more information, please visit: https://deosera.force.com/RebuildFloridaBusinessLoanFund/s/
SBA Physical Disaster Loans:
Loans are available to qualified applicant businesses of any size for uninsured losses up to $2 million to repair or replace business property to pre-disaster conditions. Loans may be used to replace or repair real estate, equipment, fixtures and inventory and leasehold improvements.
For more information, please visit: https://disasterloanassistance.sba.gov/ela/s/article/Business-Physical-Disaster-Loans
SBA Economic Injury Loans:
Loans up to $2 million are available for small businesses that sustain economic injury as a direct result of a disaster. These working capital loans are made to businesses without credit available elsewhere to help pay ordinary and necessary operating expenses that would have been payable barring the disaster.
For more information, please visit: https://disasterloanassistance.sba.gov/ela/s/article/Economic-Injury-Disaster-Loans
Small Business Development Center Business Counseling:
Certified business analysts will provide general business counseling to help access traditional SBA loans.
For more information and locations, please visit: https://fsbdcswfl.org/
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