Providing information in the fields below submits a survey to determine damage related to disaster impacts in Florida, and does NOT serve as an application for resources, including the Small Business Emergency Bridge Loan. Please click HERE to apply for the bridge loan. After filling out the survey, federal, state or local agencies may reach out to you through the contact information provided if you indicate your interest.
Surveys are public record and must be made available to the public and media upon request.
When do you anticipate re-opening?
What are your biggest challenges to re-opening?
Please Estimated physical damage (dollar amount):
How much insurance recovery funding have you received or anticipate receiving from physical or property damage?
If your business is not usable, what type of space do you require?
Estimated length of time needed (approximate number of days):
What were your business revenues during the disaster period?
What were your business revenues during the same period of the prior year?
What is the amount you have received or that you anticipate to receive?
Please estimate the total cost(physical and economic) to your business due to this emergency/disaster:
How many employees (Full Time and Part Time) do you currently have?
Number of temporary lay-offs:
Number of permanent lay-offs:
Other key factors hindering business operations (check all that apply)
Check the types of assistance your business is interested in receiving:
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