First Name *

Last Name *

Email *

Phone *

What is the name of your business? *

What is the website of your business? *

Do you solely own your business? *

Yes

No

How many years has your business been in operation? *

What platform do you currently use to process sales? *

Does your business have a storefront for customers? *

Yes

No

Is your business an online/e-commerce business? *

Yes

No

What was the original inspiration for starting your business? *

If you were chosen/awarded one of the CommunityRewards Small Business Grants, what goals would you like to achieve with this new support? *