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* 1. Business Name

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* 2. Australian Business Number (ABN)

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* 3. Business Sector

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* 4. Business Address

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* 5. Local Government Area

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* 6. Number of Employees

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* 7. Business turnover in 2019-20

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* 8. How has your business been affected by Government COVID-19 restrictions?

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* 9. Has your business been able to access financial Government support?

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* 10. Please indicate on the list below the type of expert assistance your business is seeking:

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* 11. Please describe the issue/s your business is currently facing and how the expert help selected on Q10 can assist.

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* 12. Contact Details of Person Completing the form

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* 13. Confirmation

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