COVID-19 Financial Assistance Request

1. Please enter your name. *
7. Please select your 2019 total revenue from the choices below. * 
10. How much funding do you need? * 
11. How will you use the funding? *
In order to receive disaster assistance, you will need to prove that your business was negatively affected by COVID-19. To do that, you will need ALL of the following documentation.
12. Do you have the following documentation? *
If you are unsure about any of the documentation above or do not have all the documentation, we can connect you to a counselor for help.
13. I would like additional assistance. *