Contact Form Demo (#5)Eligibility Information See if you qualify. No upfront costs First NameLast NameEmailContact NumberLegal Company NameCompany WebsiteNote: If you don't have a website, type your company's name plus ".com" and exclude "www"Full-time W2 employees in 2019*Part-time W2 employees in 2019*Full-time W2 employees in 2020*Part-time W2 employees in 2020*Full-time W2 employees in 2021*Note: excluding ownersPart-time W2 employees in 2021*Additional DetailsEvery business was impacted. Check any of the following that delayed, disrupted or negatively changed your business as a result of Covid, even if it was minor.* Full shutdowns Interrupted operations Inability to access equipment Inability to work with your vendors Cut down in your hours of operation Challenges finding and retaining employees Partial shutdowns Supply chain interruptions Limited capacity to operate Reduction in services or goods offered to your customers Shifting hours to increase sanitation of your facilityCheck any and all of the quarters that your business was impacted by COVID.* 2020 Q1 2020 Q3 2021 Q1 2021 Q3 2020 Q2 2020 Q4 2021 Q2Describe how COVID has negatively impacted the business or changed how it operates since 2019. Be as descriptive as possible.*Does any individual own 51% or more of this business?* Yes NoHow many family members does this majority owner have on payroll (if any)?Excluding owner's spousesPlease list any family members on payroll and their relationship to the majority owner.Does the business offer healthcare to employees?* Yes NoHas the business accepted PPP funds, if so, which round?* PPP Round 1 PPP Round 2 Both Not applicableWhat was your PPP Round 1 disbursement amount?What was your PPP Round 1 payment disbursement date?What was your PPP Round 2 disbursement amount?What was your PPP Round 2 payment disbursement date?Did the business use a PEO (professional employer organization) as a payroll provider in 2020 or 2021?* Yes NoHow did you hear about us?- Select -PodcastRadioOnline SearchFriend or ColleagueDigital AdSocial MediaOtherSubmit Form
