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2. 
4. The COVID-19 pandemic is a public health crisis that has enormous economic implications on our local businesses. The federal government has passed a $2 trillion aid package with more money to follow for sole proprietors and businesses to maintain basic operations and to reset and thrive during and following the pandemic. We are asking all business owners and commercial property owners to complete our online survey to help us better understand your needs.
6. First & Last Name*
7. Business Name*
9. Business Phone Number*
10. Business Email Address
12. 1. What type of business do you own?*

    1. Restaurant
    2. Service/Retail (clothing store, health care, real estate)
    3. Salon, Barbershop, Nail Salon
    4. Other
13. If you selected OTHER, please let us know what type of business below.
17. 2. What does Economic Recovery look like for your business?

    1. Assistance with overhead expenses {i.e. rent, mortgage, utilities, insurance}
    2. Cash Flow
    3. Working Capital
    4. Employee Payroll Assistance
    5. Other

    Please select one or more options if necessary
18. If you selected other, please let us know below.
22. 3. Have you applied for COVID -19 disaster Relief Funds from the state programs?

    1. New Jersey Economic Development Authority (NJEDA)
    2. Small Business Association (SBA)

    Please select all that apply
23. 3a. How much disaster relief assistance have you requested
25. 4. Have you received a reply from SBA or NJEDA?

    1. Yes
    2. No
    3. Both entities have responded back
    4. Only one entity has responded back
26. 4a. What is your status?
27. 5. Do you need assistance with completing your application?

    1. Yes
    2. No
29. 6. Would you be interested in a webinar to discuss your specific application?

    1. Yes
    2. No
30. 7. Does your business qualify for low-interest loans from a financial institution?

    1. Yes
    2. No
34. 8. What is your anticipated revenue loss or financial impact for 2020?
35. 8a. What impact will it have on your business?
37. 9. Pre-pandemic how many employees did you have?
    Please state full time & part-time employees
38. 9a. How many employees do you currently have?
    Please state full time & part-time employees
40. 9b. How many employees have been furloughed?
    Please state full time & part-time employees
41. 9c. How many employees have been laid off?
    Please state full time & part-time employees
43. 9d. Do you have any volunteers, if so, how many?
44. 10. Do you need a financial advisor to help you navigate state and federal programs for eligible funds?

    1. Yes
    2. No
48. 10. Do you currently have a website?

    1. Yes
    2. No
49. 10a. If no, do you need assistance with creating a website?
51. 11. What type of assistance would you like from the local government to provide at this time?
    {i.e. technical, financial, promotional, marketing, volunteer}
53. If you have any questions or concerns, please contact Fatimah Raymond at 908.851.5466 or email fraymond@uniontownship.com.
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55. 1. Receive an email copy of this form.
56. Email address

    This field is not part of the form submission.

57. Submit

* indicates a required field