Business Information
*Business name:
*Date business established:
*Address:
*City:
*ZIP Code:
*Business owner name:
*Business owner email:
*Business owner phone number:
*Business owner address (Street, City, ZIP):
*Do you have a current, valid Newcastle business license (please specify yes or no):
*Business License Number:
*Current number of employees, including yourself:
*Do you certify that you are current on all state and local taxes, licenses and other applicable regulatory requirements to operate in the City of Newcastle? (please specify yes or no):
*Is your business facing pending legal litigation or legal action; including Newcastle code enforcement? (please specify yes or no):
Is your business? (check all that apply): Women-owned Minority-owned Veteran-owned
*Industry sector (select one):
Restaurant/Food Services
Exercise/Fitness
Health Care
Personal Care (salons, etc.)
Retail
Other
COVID-19 Impacts on Your Business
*How has COVID-19 impacted your business to date? (check all that apply):
My business revenue significantly decreased
I've had to lay off employee(s)
My business closed temporarily due to the Governor's proclamation
I had to reduce payroll expenses (health insurance, retirement benefits, etc.)
I had to reduce or suspend lease/mortgage payments for my business location
None of the above
*Please estimate your total (gross) revenue impact comparing March-June 2019 and March-June of 2020 (write N/A if you have been in business less than a year):
March-June 2019 total (gross revenue):
March-June 2020 total (gross revenue):
*If you've been in business for less than a year, please estimate your total (gross) revenue impact comparing what you anticipated collecting March-June under normal circumstances, to the real gross revenue you collected March-June 2020 (write N/A if you have been in business more than a year):
Estimating normal conditions | March-June 2020 total (gross revenue):
Actual | March-June 2020 total (gross revenue):
*Number of employees laid off due to COVID-19 impacts. If none, write N/A:
Will this grant help you retain jobs? If so, how many?
*Likelihood of permanently closing business without grant funding? (Please specify low, medium or high):
*Describe the effect of the public health crisis on your business and how allocated funds can help:
*Explain how this grant will be used to help you recover from the impacts of the COVID-19 pandemic:
*Has your business received any state, federal, or other grants or loans during the COVID-19 crisis (example: Paycheck Protection Program loan)? If yes, please provide details. Write N/A if not applicable:
*Did you apply for PPP or other loans and were unsuccessful in applying? If yes, please provide details. Write N/A if not applicable:
*Please describe how your business/organization has participated in the Newcastle community (such as supporting local events, charities, etc.):
Is there anything else you would like to share?:
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