Form Center

2. Business/Organization Name*
4. Business Owner/Executive Director's Name*
6. Business Physical Address *
8. Business Mailing Address

   *leave blank if mailing address is same as physical address 

10. Business Phone Number *
12. Email Address*
14. Please provide a short description of your business.*
16. Year Business/Organization Was Established*
18. Number of Employees*
20. Describe how grant will be used *

    Please provide a brief description of how this grant will be used (i.e. for which eligible expenses as outlined in the program summary): 

22. Financial Loss *

    1. Yes
    2. No

    Has your business experienced a financial loss as a result of the Covid-19 pandemic?

24. Explain how this grant will impact your ability to operate your business over the next 12 months.*
26. If this is your first time applying for a Small Business Recovery Grant from the Town of Needham, please upload a tax return or an audited financial statement from your business for 2019
28. If this is your first time applying for a Small Business Recovery Grant from the Town of Needham, please upload a tax return or an audited financial statement from your business for 2020.*
30. Please upload a signed copy of the Needham Small Business Recovery Grant Affadavit here. Note that digital signatures will not be accepted. You may also mail/drop off a copy of the signed affadavit to: Amy Haelsen, Economic Development Manager, Needham Town Hall, 1471 Highland Avenue, Needham, MA 02492*
Leave This Blank:


32. Submit

* indicates a required field