Pandemic Fundraiser

Please fill out this form if you are a small local business that is struggling and could use some financial help during this pandemic.

Nominator's Name*
First Last
Nominator's email address:*
Business Name*
Business Contact Name
Business Email (if available)
Business Address*
Street Address Address Line 2 City State ZIP Code

This is where we will mail their check.
Optional message of support for business nominated:
A copy of your responses will be emailed to the address you provided.

A copy of your responses will be emailed to the address you provided.