Support Small Businesses: The Insurance Deductible Relief Fund

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Support Small Businesses: The Insurance Deductible Relief Fund

This an intake form for potential small business fund recipients. To donate, please visit - https://gofund.me/e3a4b52c

Full Name *

Email *

Phone Number *

Business Name *

Business Address *

Which fire disaster was your business affected by? *

Eaton

Palisades

Other:

What communities do you serve?? *

How many employees do you have? *

1-10

10-25

25+

How much deductible support are you seeking? *

$0 - $2,499

$2,500 - $4,999

$5,000 - $9,999

$10,000 - $14,999

$15,000 - $19,999

$20,000 and above

How was your business affected? *

Temporarily interrupted/Interrupted by evacuations.

Completely Interrupted but will be operable in the future with repair.

Total loss.

Required

If your business was a total loss, do you plan to rebuild?

Yes

Unsure

Clear selection

Would you be able to show proof of deductible payment/insurance policy deductible information? *

Yes

Other:

Can you provide a business utility Bill (water, gas, electric)

Yes

Other:

Submit

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