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2. 
4. Please let us know how you are currently doing business. How can we help?
6. First Name*
7. Last Name*
8. Email*
10. Business Name*
11. Phone Number*
12. Ext.
13. Web Address
15. Facebook Handle
16. Instagram Handle
17. Twitter Handle
18. Other Social Media
22. What type of business do you have?*

    1. Restaurant
    2. Retail
    3. Home Based
    4. Other
23. Please describe your business*
25. How can customers patronize your business?*

    1. Open for business as usual
    2. Take Out/Pickup Orders Only
    3. Delivery Orders Only

    1. Online Orders Only
    2. Other
26. If other, type text here.
30. Have you laid off any employees?*

    1. Yes
    2. No
31. Number of employees laid off?
32. Are you contemplating laying off employees?*

    1. Yes
    2. No
33. Do you need to temporarily hire employees?*

    1. Yes
    2. No
37. The following would help me: *

    1. Small business 1:1 mentoring
    2. Other
38. Please explain if Other.
40. Would you like us to contact you?*

    1. Yes, by Email
    2. Yes, by Phone
    3. No
41. If yes, please tell us what your questions are so we can be prepared when we contact you.
Leave This Blank:


43. 1. Receive an email copy of this form.
44. Email address

    This field is not part of the form submission.

45. Submit

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