Small Business Grant & Stimulus Application

What is Your Business Name?:

What Category Is Your Business?

How long have you been in business before this Pandemic?

What is the average dollar amount spent by a new customer or client in your business?

What was your business generating per month in revenue before this Pandemic?

Do you have a physical location?

 Yes No

If yes, Please tell us the address:

Do you have a website currently:

 Yes No

If yes, please tell us the URL Address:

Do you have a YELP Listing:

 Yes No

If yes, please include the link to the YELP Listing here:

Before the Pandemic, were you doing any advertising online at all?

(In Example: Facebook, Google, Yelp, TV, print media, etc.

Are there any partners in your business or additional decision makers in your company?

Do you have any employees, if so how many?

What Is Your Main Role at Your Company Day to Day?

Main Email address:

Secondary Email Address:

Direct Phone Number:

Business Phone Number:

What time Zone are you On?

Have You Previously Applied for Any Other Stimulus?

Give us any details regarding the challenges in your business that you perhaps may have had before the Pandemic