Business Relief Funding Program Registration

Business Relief Funding Program Registration

with the African American Entrepreneurs Association
Name*

First NameLast Name
E-mail*
Work Phone*

Area CodePhone Number
Cell Phone*

Area CodePhone Number
Company*
Company Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Company Website
Hurricane DamageFlood DamageEconomic Hardship
Is your commercial space usable?*
0-22-1010-2525 or more
How many days/work hours did you lose?*
Please provide some information regarding the damage.*
Was there damage to equipment?*
YesNo
Rent my commercial locationOwn my commercial locationWork from a Home Office
Estimated Value of Damages for (Product/Goods/Food)blanks* . Estimated Value of Building Damages blank.
If damage is not obvious (i.e., electrical), please include an image of equipment damage and note the type of damage.

Please have images of the damage emailed to relief@aaeassociation.org

One of the AAEA Team members will contact you within the next 7-10 business days to review your application and discuss the next steps.

We understand that you are at a critical point in your recovery, and we are here to help. If you have any questions, please call (800) 671-1397.
FacebookLinkedInVolusia County Economic DevelopmentAAEA WebsiteOther
Please verify that you are human*
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