Business Name*
*
Business Address*
*
Economic region*
Business phone*
* x
Contact name*
Email address*
*
Contact phone*
*
Are you an Indigenous owned business?
Are you a woman-owned business?
Type of physical location
If Other, please specify
Type of Business (specify your sector)
If Other, please specify
If Tourism, please indicate which sub-sector
If Other, please specify
How long has your business been in operation: Years
How many employees does your business have, including yourself and family members?
Needs Identification
Has your business been directly impacted by wildfires in 2023?
If Yes, please explain what functions of the business were impacted and their status
If No, was your business impacted by other means? (Please explain)
If Other, please specify
What is the estimated financial impact as a result of the wildfires? (include sales, damages, etc).
What are your immediate needs
Critical papers, business records and policies
Are your critical papers/records secure/backed up?
If Yes, do you need assistance in accessing them?
Do you have business insurance?
Does your business insurance cover fire, smoke damage losses?
Does your business insurance cover loss of income, inventory and/or interruption of business?
Would you like someone to contact you regarding any specific issues or to provide additional assistance once the situation has improved?
Notes
Phone number
Please verify that you are a real person*