COVID-19 Relief Program

Are you a consumer or business customer in need?

First Name

Last Name

Email Address

Phone Number

Relief Desired

Brief explanation of relief desired above

Brief explanation of what adverse economic effects COVID-19 has had/is having on your business

When did the impact start?

What is the estimated end date of impacts?

What are your business' revenues during the COVID-19 outbreak time period?

What were your business' revenues during the SAME period of the prior year?

Amount of business interruption insurance received or anticipated, if any?

How many employees did you employ prior to the COVID-19 outbreak?

How many employees do you employ at this time? (during the COVID-19 outbreak)?