July 2022 Major Flood Event - Business Impact and Needs Analysis

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* 1. Business Name

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* 2. Business Street Address

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* 3. Name of Business Owner/Manager

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* 4. Mobile Phone Number

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* 5. Email

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* 6. Business Type

Sole Trader

Company

Business Partnership

Home Based Business

Not for Profit

Other (please specify)

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* 7. Please indicate your primary industry (tick only one).

Agriculture, Forestry + Fishing

Financial + Insurance Services

Accommodation

Food Services including restaurants, cafes, pubs, clubs and coffee shops

Wine production/viticulture

Administrative + Support Services

Construction

Other Services

Professional, Scientific + Technical Services

Manufacturing

Rental, Hiring + Real Estate Services

Retail Trade

Transport, Postal + Warehousing

Education + Training

Wholesale Trade

Health Care + Social Assistance

Arts + Recreation Services

Information Media + Telecommunications

Mining

Other tourism

Other (please specify)

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* 8. Does your business have flood insurance?

Yes

Other (please specify)

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* 9. Number of employees

0 employees

1 - 4 employees

5 - 20 employees

20 + employees