DOOR COUNTY BUSINESS ASSISTANCE REQUEST
Please complete this form to request business counseling and identify possible financial assistance.  Your submission will trigger a call with DCEDC Staff to collect additional information.  All information is STRICTLY CONFIDENTIAL and will be used only for the purpose of assisting your business.
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Business Name *
Business Owner *
Business Owners Phone *
Business Owners Email *
Main Business Address *
City *
State *
Zip Code *
Additional Key Contact 1 (Name, Phone, Email, Position)
Additional Key Contact 2 (Name, Phone, Email, Position)
Additional Key Contact 3 (Name, Phone, Email, Position)
Additional Key Contact 4 (Name, Phone, Email, Position)
What is the business revenue impact (Dollars or Percentage) are currently you projecting? Provide additional comments as needed.
What is the employment impact (Number of Employees or Percentage) are currently you projecting?  Provide additional comments as needed.
What other ways has your business already been impacted?
Are there additional impacts on your business that you are projecting?
What steps have you already taken to respond to COVID-19?
What additional steps do you have ready to implement in response to further developments?
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