Heart on Main Street Survey

Heart on Main Street Grant Application
Heart on Main Street provides natural disaster relief grants to eligible independent retailers based on an as needed basis.

Eligibility

Independent Retailers are eligible to apply for a natural disaster relief grant within one year of experiencing a federally declared natural disaster. Heart on Main Street grants are only available to independent retailers based in the United States, including US territories and retailers are only eligible for one grant per year.
Name

First NameLast Name
Business Name
Business Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Business Website
Phone Number
Please enter a valid phone number.
Years in Business
Sales Volume
Are you currently open for business?

YesNo
Do you have insurance coverage for the damage?

YesNo
Are you looking for inventory or monetary assistance?

InventoryMonetaryBoth

By submitting this application to the Heart on Main Street natural disaster relief fund you consent to sharing your information with an internal review committee.
Should be Empty:

Heart on Main Street Grant Application