Business Disaster Relief Grant Application

After submitting the application, I understand I will be responsible for uploading required documentation:

Police, fire, government agency, insurance and/or news report documenting the qualifying disaster
Supporting documentation such as repair estimates, replacement estimates, inventory loss records or insurance documentation
Copy of Insurance claim
Photos of damage (labeled with item, location, and brief description of damage shown)

Company

This field is for validation purposes and should be left unchanged.

Business Information

Business Name(Required)

ARA ID# (if applicable)

Owner's Name(Required)

Mailing Address(Required)

Street Address City State / Province / Region

Contact Person/Title

Phone(Required)

Email(Required)

Annual Revenue Amount

Fiscal Year

Inventory Demographics

Party/Event %(Required)

General Tool %(Required)

Construction %(Required)

Number of Staff(Required)

Number of Branches(Required)

Years in Business(Required)

Name of Insurance Carrier(Required)

Amount of Claim $(Required)

Insurance Filed(Required)

Yes

Insurance claim status: filed, pending, approved, denied or not applicable. If denied or not applicable, please briefly explain:(Required)

Disaster Information

Type of qualifying disaster: severe storm, tornado, hurricane/tropical storm, flood/flash flood, wildfire/fire, earthquake, winter storm/ice storm, straight - line wind, mudslide/landslide or other catastrophic event.

Description, date and location of qualifying disaster(Required)

Proposed Request(Required)

Describe the qualifying disaster, when it occurred, where it occurred and how it directly caused the loss or damage included in this request.

What are the business needs or problems to be addressed through this request?(Required)

How will the funds be used?(Required)

List any other recovery assistance requested or received, including insurance proceeds, government assistance, charitable support, vendor credits or community fundraising.(Required)

Total value of loss $

Additional Information you wish to provide