Business/Organization Information

Organization Name:*
Contact Name:*
Contact Phone: Use the format: 319-555-5555
Contact Email:
Physical Address:*
Physical Address:
Physical City, State, Zip:*
Same as above Not Same
Mailing Address:*
Mailing Address:
Mailing City, State, Zip:*
Organization Email:
Organization Phone: Use the format: 319-555-5555
Organization Fax:
Preflood Employees:* Please enter only numbers.
Postflood Employees:* Please enter only numbers.
Loss Description:
Uninsured Loss Amount:* $ Please enter only numbers.
 
Critical Needs:
Needs Cost:* $ Please enter a number.
Amount Requested:* $ Please enter a number.
I plan to invest in the commercial zones in Cedar Rapids affected by the flood. (Check if Yes)
I own the building(s) within which the Business is operated. (Check if Yes)
Banker Organization:*
Banker Contact Name:*
Bank Address:*
Bank Address:
Bank City, State, Zip:*
 

* I attest to all of the following:

That the information in this Application is true and complete. 
That the Business intends to continue in business in Cedar Rapids. 
That the Business understands that representatives of the Cedar Rapids Area Chamber of Commerce or the CRBRF reserve the right to contact the Business’s banker to discuss the financial history/viability of the Business

The electronic filing of this Application will be deemed to have been signed and constitutes agreements with the terms set forth above.
All fields marked with * or that are YELLOW are required.