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Business Recovery Grants App Form
Organization Legal Name:
Doing Business As Name:
Business Physical Address (Street-City-Zip):
CEO / Owner Full Name:
Primary Contact Full Name & Title:
Primary Contact Phone (if different from Business phone):
Primary Contact Email:
Is Your Business A Current Chamber Member?
Do Not Know
Statement of Business Purpose, Product(s), Service(s):
My Business Insurance Coverages Include (Having or not having insurance will not impact a request for funding)
Home-based Business Insurance
I do not have any of these coverages
Other Sources of Funding Being Received for Business Recovery:
If Granted, Money Will Help to Cover:
Signature of Owner:
Send me a copy of my responses.
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