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Employment Information <br /> Current Operating Status <br /> Open for business or operating online ❑ <br /> Open for business but with reduced hours ❑ <br /> Closed by still operating onsite or remotely ❑ <br /> Completely closed ❑ <br /> What was your total employment prior to the emergency declaration? <br /> Were you forced to make any employment changes as a result of the emergency declaration? <br /> Yes ❑ No ❑ <br /> Please describe: <br /> Please describe any other impacts you have experienced as a result of COVID-19: <br /> Financial Information <br /> Were you forced to close due to the Governor's declaration mandate? Yes ❑ No ❑ <br /> What was your annual gross receipts or sales from last year? <br /> What is your projected gross receipts or sales for the next three months? <br /> Estimated monthly gross receipts or sales loss due to COVID-19. <br /> Have you filed a business interruption insurance claim? Yes ❑ No ❑ <br /> Have you applied for financial assistance from the Federal or State Government?(Please provide <br /> evidence.)Yes ❑ No ❑ <br /> Please describe: <br /> 2 <br />