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2. 
4. Business Name*
5. Contact Person*
7. Business Address
9. City
10. State
11. Zip
13. Daytime Phone
14. Contact Email
16. Disclaimer*

    I understand that failure to include a daytime phone or contact email may prohibit the BRTF from contacting me.

    1. I understand.
20. Indicate below which topics you'd like to know more about (check all that apply).

    1. SBA loans and grants (EIDL, PPP)
    2. Workforce (employee relations, training, retention, etc)
    3. Marketing (websites, social media, digital platforms, etc)
    4. Utility payments
    5. Financial planning
    6. Other
22. Describe your "other" here.
24. Thank you! A representative from the Business Recovery Team will contact you as soon as possible.
Leave This Blank:


26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit

* indicates a required field