To better help Tri County Economic Development District document the economic impact of COVID-19, area businesses are encouraged to complete and submit this simple form. This form is not required, but it helps to provide clarifying information that supports the documentation the state is required to submit to the U.S. Small Business Administration when requesting an Economic Injury Disaster Loan Declaration.

Thank you for your assistance.

  • Business Owner's Name * Required
  • Business Owner Mailing Address * Required
  • Business Street Address * Required
  • When did the impact start?
    Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Estimated dollar loss to real property (building) if owned:
  • *includes machinery and equipment, furniture and fixtures, inventory, leasehold improvements, etc.
  • Form Completed by: * Required
  • This field is for validation purposes and should be left unchanged.