Erie Small Business Emergency Relief Grant Application

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* 1. Contact Information:

Name

Email Address

Phone Number

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* 2. Business Information:

Company

Address

City/Town

State/Province

ZIP/Postal Code

Type of Business (bakery, child services, etc.)

NAICS (if known)

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* 3. What are the impacts to your business due to COVID-19 (check all that apply)?

Business closures

Reduced hours of operation

Employee layoffs

Revenue decline

Increased operating costs (e.g. employee paid leave)

Access to capital to address increased costs

Inability to respond to home-delivery requests

Interrupted supply/delivery

Employee absenteeism

Inability to serve customers

Decreased customers/revenue

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* 4. Number of employees as of March 2020:

2-10

11+

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* 5. Gross annual revenue before COVID-19:

Less than $250,000

Between $250,000-$500,000

Between $500,000-$750,000

Between $750,000-$1M

Between $1M-$2M

Greater than $2M

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* 6. Grant amount you are applying for:

$5,000

$10,000

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* 7. If applicable, provide the percentage (%) of change in revenue by comparing last month 2019 revenue with last month revenue 2020.

((2019 rev - 2020 rev) / 2019 rev) x 100 = % in change

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* 8. What is your plan to stabilize and continue your business during and after the stay-in-place order?

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* 9. Are you investing your own funds to support your business? If yes, how much?

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* 10. Will you be applying for the Economic Injury Disaster Loan or the Paycheck Protection Program loan offered by the federal stimulus package through the CARES Act (check all that apply)?

Economic Injury Disaster Loan (EIDL)

Paycheck Protection Program loan (PPP)

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* 11. Are you current with all financial obligations (rent, utilities, sales tax remittance, etc.)?
If not, please provide a list of obligations that are not current along with the duration of the delinquency.

Erie Small Business Emergency Relief Grant Application

Question Title

* 1. Contact Information:

Question Title

* 2. Business Information:

Question Title

* 3. What are the impacts to your business due to COVID-19 (check all that apply)?

Question Title

* 4. Number of employees as of March 2020:

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* 5. Gross annual revenue before COVID-19:

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* 6. Grant amount you are applying for:

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* 7. If applicable, provide the percentage (%) of change in revenue by comparing last month 2019 revenue with last month revenue 2020. ((2019 rev - 2020 rev) / 2019 rev) x 100 = % in change

Question Title

* 8. What is your plan to stabilize and continue your business during and after the stay-in-place order?

Question Title

* 9. Are you investing your own funds to support your business? If yes, how much?

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* 10. Will you be applying for the Economic Injury Disaster Loan or the Paycheck Protection Program loan offered by the federal stimulus package through the CARES Act (check all that apply)?

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* 11. Are you current with all financial obligations (rent, utilities, sales tax remittance, etc.)?If not, please provide a list of obligations that are not current along with the duration of the delinquency.

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* 12. Any other comments you would like to share?

* 7. If applicable, provide the percentage (%) of change in revenue by comparing last month 2019 revenue with last month revenue 2020.

((2019 rev - 2020 rev) / 2019 rev) x 100 = % in change

* 11. Are you current with all financial obligations (rent, utilities, sales tax remittance, etc.)?
If not, please provide a list of obligations that are not current along with the duration of the delinquency.