Small Business Relief Program Nomination

Nominate a local business! Our mission is to raise $10,000 across communities and match $10,000 so we can provide 20 businesses with a $1,000 donation to help offset past debt incurred from being closed or to assist with their current operations.

Nominate a business you think deserves to be a recipient of this program. Please take your time and answer all questions fully as each question is weighted to ensure a fair selection process.
Contact Information
Your Name*
First Last
Your Email*
Business Name*
Business Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Business Phone Number*
Business Website (if existing)
Business Email (if known)

Contact Information