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Small Business Recovery Grant

2. For assistance with this application process, please contact City Staff at SBRGCrestview@CityofCrestview.org
4. Business Name
5. Business Tax Receipt #
9. Business Address
11. City
12. State
13. Zip Code
15. Phone Number
16. Email Address
20. Property Owner Address
22. City
23. State
24. Zip Code
26. Phone Number
27. Email Address
31. Financial Impact
    Describe the financial impact of the Safer at Home order on your business as it relates to COVID-19
33. Number of Employees
    Full-Time Equivalent
34. Revenue Lost
    Estimated loss in revenue in March, April, and May.
35. Type of Business
37. For Profit Status

    1. Non Profit
    2. For Profit
38. Did you experience a mandatory closure?

    1. Yes
    2. No
39. Did the Safer at Home order require a reduced schedule?

    1. Yes
    2. No
40. If restaurant, did the business location have a drive-thru prior to the virus?

    1. Yes
    2. No
42. Amount Requested
43. Upload Documentation
47. Electronic Signature Agreement

    I hereby certify that the data provided above is true and correct to greatest extent of my knowledge. I further certify that I understand and acknowledge the following; 1) That the City of Crestview reserves the right to verify the data provided above, 2) The City of Crestview will reject all requests that do not meet the requirements as provided in the City’s Grant Procedures, 3) This request will be processed in the order it was received and as quickly as reasonable, 4) The processing of the application does not guarantee any funding, 5) Any information found to be fraudulent may result in the refund of any funds paid based on the false information, 6) Businesses who fail to remain in operation for at lease 30 days following receipt of grant funding will be required to refund the grant funding to the City.

    1. I agree.
49. Electronic Signature
Leave This Blank:


53. 1. Receive an email copy of this form.
54. Email address

    This field is not part of the form submission.

55. Submit

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