Maryland SBDC - Estimated Adverse Economic Impact Survey, March 2020
IMPORTANT NOTE: One e-mail used to send this form out contained a partially inaccurate instruction to download this form and attach it to a reply via e-mail. That step is NOT necessary - please just complete this form and submit it when finished.

Accurate responses to the questions below will assist in evaluating a request for an economic injury disaster declaration from the U.S. Small Business Administration. Securing an economic injury disaster declaration from the SBA is critical to ensuring access to COVID-19 disaster relief loans for local businesses.
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BUSINESS CONTACT INFORMATION
Name of Business Owner *
Name of Business *
Business Telephone Number *
Business E-mail Address *
BUSINESS ADDRESS
Street Address *
Street Address 2
City *
State *
Zip code *
MAILING ADDRESS
(If different from business address)
Street Address
Street Address 2
City
State
Zip Code
Has the global COVID-19 pandemic affected your business? *
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