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

* indicates a required field