COVID-19 Business Inquiry Form

Thank you for taking time to complete this form which helps us better understand the impact of COVID-19 on your business. The information provided will also help us determine the appropriate DC agency and resources to connect you with, and further informs our economic recovery efforts. For information and resources regarding COVID-19, please visit coronavirus.dc.gov.

CONTACT INFORMATION

First Name*

Last Name*

Email Address*

Phone Number*

BUSINESS INFORMATION

Company Name*

Street Address*

City, State*

ZIP Code*

Sector*

Select or enter value

Sector (Other)

Number of Employees*

BUSINESS IMPACT

Please describe how your business has been impacted by COVID-19.

What changes or challenges does your company anticipate?

Select or enter value

What type of business resources or immediate support are you seeking?

Select or enter value

List Business Resources or Immediate Support if "Other" selected from above field:

What is the lost revenue percentage you anticipate as a result of COVID-19?

0-5%

6-10%

11-15%

16-20%

21-25%

26-30%

31% or more

What is your business operating status?*

Select or enter value

If you are still open or operating modified business hours, what are your business hours?

What are your normal business hours (prior to COVID-19 disruption)?

For restaurants, please select the services you are providing:

Select or enter value

Are you providing any free or discounted services to vulnerable residents?

Yes

INQUIRY

How may we help?*

Your questions will be routed to the appropriate DC Government agency or agencies that can assist.

Would you like to be added to our distribution list to receive additional information and updates?

Yes

Send me a copy of my responses

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