First Name

Last Name

Legal Company Name

Your Position with the Company

Email Address

Phone Number ( Only Input Numbers No spaces or Dashes )

Full-time W2 employees in 2021*

0-1 Employees 2-4 Employees 5-99 Employees 100+ Employees

Part-time W2 employees in 2021*

0-1 Employees 2-4 Employees 5-99 Employees 100+ Employees

Every business was impacted during the pandemic. Check any of the following that delayed, disrupted or negatively changed your business as a result of Covid, even if it was minor.*

Full Shutdowns Partial Shutdowns Interrupted operations Supply chain interruptions Inability to access equipment Limited capacity to operate Inability to work with your vendors Reduction in services or goods offered to your customers Cut down in your hours of operation Shifting hours to increase sanitation of your facility Challenges finding and retaining employees Other