Business Recovery Resource Request

Business Recovery Resource Request

Event/Incident*

Select

Business Name*

Business Address*

City*

County*

Zip Code*

Contact First & Last Name*

Contact Email*

Contact Phone*

Phone

Physical Damage:

(Physical damages include repair or replacement of real property, machinery, equipment, fixtures, or inventory)

Is your business able to open and be operational?

Yes

If closed, how long until you expect to reopen?

Estimated length of time (number of days, weeks, or months)

Did your business experience physical damage?

Yes

Did your business experiencing flooding?

Yes

(Economic damages include the inability to meet necessary financial obligations, such as payroll or rent)

Did your business suffer economic damages?

Yes

Please estimate the total cost (physical and economic) to your business due to this emergency/disaster:

(Resource needs include services, supplies, temporary space and equipment)

If your business requires temporary space to operate, what type of space is needed?

Select or enter value

Please list your business resource needs.

Assisting Community Partner

Select

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