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
Your answer
Business Address
Your answer
Contact Name
Your answer
Contact phone number
Your answer
Are you a minority owned business (this is for data collection purposes only)
What goods or services does your business provide (please explain what your business is)?
Your answer
How long has your business been in operation?
Your answer
What is your gross annual revenue?
Your answer
What are your total annual expenses?
Your answer
How many full-time employees do you have?
Your answer
How many part-time employees do you have?
Your answer
How much funding are you requesting?
Your answer
What are your most immediate needs/expenses, in order of priority and amounts listed, to keep your business operational during the shut down. *
Your answer
What is the minimum amount of monthly funding needed to help you cover your most urgent business-sustaining expenses?
Your answer
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?
Your answer
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. *
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