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Estimated Disaster Economic Injury Worksheet for Businesses

  1. 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. This information in any other format would also be acceptable.

  2. Owner Details

  3. Business Owner Mailing Address

  4. Business Address (Location)

  5. Estimated Adverse Economic Impact

  6. Physical Damage to Business Property

    If your business also suffered property damage, please answer the following questions:

  7. Note: Contents includes machinery and equipment, furniture and fixtures, inventory, leasehold improvements, etc.

  8. Leave This Blank:

  9. This field is not part of the form submission.