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Estimated Disaster Economic Injury Worksheet for Business

This form is not required, but is a convenience in clarifying the supporting documentation the state is required to submit to the U.S. Small Business Administration when requesting an Economic Injury Disaster Loan Declaration.
Owner Details
Business Owner Mailing Address
Business Street Address
Estimated Adverse Economic Impact
Format: M/d/yyyy
Format: M/d/yyyy
Physical Damage to Business Property:
If your business also suffered property damage, please answer the following questions:
* includes machinery and equipment, furniture and fixtures, inventory, leasehold improvements, etc.
Form Completed By: