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Who We Are
What We Do
Business Law
Class Actions & Mass Torts
Family Law
Personal Injury
Property Damage
Real Estate Law
Trusts and Estates
Things to Know
Careers
In the News
Law Defined Blog
News Brief
Events & Partners
Videos
Testimonials
Client Portal Login
Contact Us
(239) 791-7950
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COVID-19 Business Impact Questionnaire
Has your business suffered an economic loss due to COVID-19?
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Yes
No
Has COVID-19 been confirmed at your place of business?
Yes
No
Who was confirmed with COVID-19
Employee
Customer
Other
On what date did this happen?
Date Format: MM slash DD slash YYYY
I am sorry but we cannot help you at this time. Please contact us at (239) 791-7950 if you have any questions,
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Annual Gross Revenue for the business:
Estimated lost revenues from COVID19:
Name of Authorized Business Representative
*
First
Last
Telephone Number
*
EMAIL FOR LEGAL CORRESPONDENCE
*
Business Interruption Insurance
Do you have Business Interruption Insurance?
Yes
No
Name of Insurance Provider
Name of Underwriter (If Known)
Have you made a claim with your insurance provider?
Yes
No
Event Cancellation Insurance
Do you have Event Cancellation Insurance?
Yes
No
Name of Insurance Provider
Name of Insurance Underwriter
Name of Cancelled Event
Please Provide a Description of the Event
Date of the Event
Date Format: MM slash DD slash YYYY
Date of Cancellation
Date Format: MM slash DD slash YYYY
Have you submitted a claim for this event with your insurance provider?
Yes
No
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