Covid 19 Communication Survey
RequiredRequired Question(s)
For most of us, this is our first pandemic.  We want to communicate your business situation and resource needs to officials that could potentially assist in offering some sort of relief.  The goal of this survey is to obtain information from you for direct communication to the aforementioned officials.  
 
1.
Please enter the information indicated below.

By entering my personal information, I consent to receive email communications from the survey author's organization based on the information collected.

First Name:
Last Name:
Company Name:
Work Phone:
Email Address:
emailaddress@xyz.com
Address 1:
Address 2:
City:
State/Province
(US/Canada):
Postal Code:

2.

How has the Covid 19 pandemic impacted your business? 

 

1000 characters left.
3.

What sorts of relief measures are important for your business to continue future operations at a high level?

 

1000 characters left.
4.

What sorts of small business specific initiatives would aid your business immediately?

 

1000 characters left.
5.

Is there anything else you would like to add concerning the pandemic and your business?

 

1000 characters left.
Required 6.

May we share your responses with appropriate elected officials and/or governmental entities?

Yes
No
  • Comment:

  • 500 characters left.