COVID-19 Lost Wages Form - DIG Your Journey

Your Name*
What Is Your Email Address?*
This email is so that we can get in touch with you in case we have any questions. Also we will use this to let you know when the post is up.

Name of Business
Please enter the name of the business that was impacted by COVID-19.
What's The Web Address?
Please provide the website address of the business that was affected by COVID-19. For example: https://dianna.com/
Location
Where is your place of business?

Tell Us About The Business & What You Do
If your restaurant, bar or nightclub had to close or modify hours because of coronavirus, tell us about this place before COVID-19.
What Happened To Your Restaurant/Bar/Nightclub?*
- Temporarily Closed/Suspend Business
- Modified Operations/Shortened Hours
- Closed Indefinitely
Are You Working Now?
- Yes
- No

Tell Us About What You're Doing Now
What Services Do You Provide?
- Pick-Up
- Delivery
- Catering
- Virtual Training
Are You Selling Gift Cards Online?
- Yes
- No
- Not Yet
Address
If your business has a physical location, please enter the information here.
Street Address Address Line 2 City State ZIP Code
Phone
What is the best number for customers to reach you?
What's Are Your Hours?
Do you have modified hours? When are you available?
Sun Mon Tue Wed Thu Fri Sat
Do You Have A New Menu?
Upload a PDF of your new or modified menu.
Drop files here or
Accepted file types: pdf, Max. file size: 10 MB.
What Is Your Blog or Web Address?
Have you started a new business or have a side gig you're promoting? Please provide the URL. For example: https://dianna.com/

Your Social Media
What hashtag(s) would you like us to use when publishing your profile on social media? For example: #foodie #eatlocalaz
What's Your Instagram?
For example: https://www.instagram.com/digscottsdale/
What's Your TikTok?
For example: https://twitter.com/digcottsdale
What's Your Twitter?
For example: https://twitter.com/digcottsdale
What's Your LinkedIn?
For example: https://www.linkedin.com/company/digscottsdale
What's Your Facebook?
For example: https://www.facebook.com/digscottsdale

Photos
Please provide images of your food, drinks or yourself. Please have at least one image in landscape mode.
Drop files here or
Accepted file types: jpg, png, jpeg, Max. file size: 20 MB, Max. files: 5.

Additional Information
What else would you like us to know? How can the community support you?
Gratitude
What are you grateful for during this experience? Name three things that have really touched you during this time.
Name
This field is for validation purposes and should be left unchanged.

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