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Business Damage Assessment Survey (* is required)

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.

Event/Incident: *

Business Name: *

Business Location:

Address 1: *

Address 2:

City: *

County: *

State:

Zip Code: *

Contact Details:

First Name: *

Last Name: *

Email: *

Phone:

Business Type:

Currently open for business? *

YesNoAlternate locationAlternate hours

Did your business location suffer damages?

YesNoUnsure

Type of Damage?

PhysicalEconomic / Lost Revenue

Physical Damage:

If your business is not usable, what type of space do you require?

Square feet needed:

Estimated length of time needed (approximate number of days):

Economic Damage:

Did you lose business due to this emergency/disaster?

YesNoUnsure

What were your business revenues during the disaster period?

What were your business revenues during the same period of the prior year?

Do you have business interruption insurance?

YesNoUnsure

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?

Have you or will you lay off employees as a result of this emergency/disaster?

YesNo

Do you sell food products?

YesNo

Have you registered for disaster assistance with FEMA?

YesNo

If you have not registered with FEMA, please visit www.DisasterAssistance.gov

Other key factors hindering business operations (check all that apply)

Would you like to be contacted with more information about business relief services and programs?

YesNo

Check the types of assistance your business is interested in receiving:

Emergency Bridge Loan - A short-term, interest-free loans up to $50,000 available to small business owners who have between 2 to 100 employees, have been in operation for at least one full year and have experienced physical or economic damage.
SBA Physical Disaster Loans - Loans are available to qualified applicant businesses of any size for uninsured losses up to $2 million to repair or replace business property to pre-disaster conditions. Loans may be used to replace or repair real estate, equipment, fixtures and inventory and leasehold improvements.
SBA Economic Injury Loans - Loans up to $2 million are available for small businesses that sustain economic injury as a direct result of a disaster. These working capital loans are made to businesses without credit available elsewhere to help pay ordinary and necessary operating expenses that would have been payable barring the disaster.
Small Business Development Center Business Counseling - Certified business analysts will provide general business counseling to help access traditional SBA loans.

(Click here to register with FloridaDisaster.biz and save your Business Damage Assessment Survey)

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