Maryland SBDC - Estimated Adverse Economic Impact Survey, March 2020
IMPORTANT NOTE: One e-mail used to send this form out contained a partially inaccurate instruction to download this form and attach it to a reply via e-mail. That step is NOT necessary - please just complete this form and submit it when finished.

Accurate responses to the questions below will assist in evaluating a request for an economic injury disaster declaration from the U.S. Small Business Administration. Securing an economic injury disaster declaration from the SBA is critical to ensuring access to COVID-19 disaster relief loans for local businesses.
BUSINESS CONTACT INFORMATION
Name of Business Owner *
Your answer
Name of Business *
Your answer
Business Telephone Number *
Your answer
Business E-mail Address *
Your answer
BUSINESS ADDRESS
Street Address *
Your answer
Street Address 2
Your answer
City *
Your answer
State *
Your answer
Zip code *
Your answer
MAILING ADDRESS
(If different from business address)
Street Address
Your answer
Street Address 2
Your answer
City
Your answer
State
Your answer
Zip Code
Your answer
Has the global COVID-19 pandemic affected your business? *
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