Request for Relief: Business Support Fund
DISCLAIMER: We will distribute funds as equitably as possible throughout the neighborhood. As money comes in, we will allocate it promptly to businesses based on the requests our committee has reviewed and approved. While we cannot *guarantee* funding, we are working to do our best.

You DO NOT need to be a Go Mt. Airy Business Association member to apply.
Email address *
I operate a business in Mt. Airy *
Business Name
Business Address
Contact Name
Contact phone number
Are you a minority owned business (this is for data collection purposes only)
Clear selection
What goods or services does your business provide (please explain what your business is)?
How long has your business been in operation?
What is your gross annual revenue?
What are your total annual expenses?
How many full-time employees do you have?
How many part-time employees do you have?
How much funding are you requesting?
What are your most immediate needs/expenses, in order of priority and amounts listed, to keep your business operational during the shut down. *
What is the minimum amount of monthly funding needed to help you cover your most urgent business-sustaining expenses?
If you receive these funds, how much longer do you anticipate you'll be able to operate? If closed, will these funds enable to cover your fixed expenses and allow you to re-open after the mandatory shutdown ends?
Have you or are you planning on applying to other business relief programs? *
To what other programs have you applied or do you plan on applying to?
If you'd like assistance being connected to any of these other services, please check the appropriate box. *
Required
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