Webster County Small Business Recovery Grant Application 2022
*In order to complete and submit this form, you will need to upload a copy of your 2021 balance sheet or schedule C.
Business Legal Name
DBA
Federal ID # (if available)
Owner's Name
First Name
Last Name
Primary Contact Person
First Name
Last Name
Physical Address of Business
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mailing Address of Business
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Business Phone Number
*
Please enter a valid phone number.
Contact Email
*
example@example.com
Date Business Was Established in Webster County
*
-
Month
-
Day
Year
Date
Grant Amount Request ($2,500-$10,000)
*
What is the primary function of your business and how does your business impact the community?
*
Was your business shut down or were operations limited as a result of a government order?
*
Yes
No
If yes, please list dates and specify if business was closed or limited in operations.
How many employees (FTE) did you have on March 1, 2020?
*
How many employees (FTE) do you have today?
*
Describe the negative economic impact of Covid-19 to your business.
*
What is the loss of revenues from March 1, 2020-August 1, 2021?
*
What were your total expenses from March 1, 2020 - August 1, 2021?
*
Describe how grant funds would be used.
*
Have you applied for compensation from other sources as a result of the pandemic?
*
Yes
No
Please list other compensation requests and amounts received.
Is the applicant entity up to date and in good standing with the Department of Revenue for filings and payments of sales, use and withholding taxes?
*
Yes
No
Is there anything else you'd like us to know?
Balance Sheet or Schedule C as of December 31, 2021
*
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