City of Providence Economic Injury Disaster Declaration Request Form

Economic Injury Disaster Declaration Request Form

Accurate responses to the questions below will assist in evaluating a request for an economic injury disaster declaration from the U. S. Small Business Administration. This is not an application for assistance.

Name(Required)

First Last

Business Name(Required)

Business Type(Required)

Business Address(Required)

Street Address Address Line 2 City State ZIP Code

Business Phone(Required)

Business Email(Required)

How have you been affected by the I-195/Washington Bridge closure or the flooding on 12/18 or rain event 1/9-1/10?(Required)

If you have lost revenue, please estimate how much (estimated numbers are fine)?

Would you like a call back?(Required)

Yes

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City Of Providence

Mayor Brett Smiley

Economic Injury Disaster Declaration Request Form

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Economic Injury Disaster Declaration Request Form

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