PayItForwardMHCRound2 - The 30 Day Fund

QUESTIONNAIRE TO APPLY FOR A SECOND ROUND OF FUNDING

If you are a business applying for the first time and have not been previously funded, you must submit an application by clicking here.

To apply for an additional $2,000 forgivable loan through the Virginia 30 Day Fund and the Harvest Foundation’s Pay It Forward MHC program, please complete the form below:

Please note that at this time, second round funding is open only to businesses located in Martinsville / Henry County who were funded prior to March 31, 2021. Please direct any questions to [email protected].

Business Owner Name (First and Last)*
Business Owner Phone Number*
Business Owner Email Address*
Business Name*
Business Address*
Street Address City State / Province / Region ZIP / Postal Code
Is your business located in Martinsville / Henry County?*
- Yes
- No
Please upload a copy of your current Martinsville / Henry County Business License*
Please tell us how the funds previously awarded were used to support your business during the Covid-19 pandemic (ie: payroll, rent/mortgage, utilities, personal protective equipment, general expenses, etc.). Please be specific. If your business has not been funded previously, you must submit a first-time application and cannot use this form to apply.*
How has the Covid-19 pandemic affected your business over the past year and what has been your greatest challenge as a business / business owner?*
Please describe any significant changes or developments in your business since first receiving the funds (ie: do you have the same number of employees? Have you had to pivot your business model?)*
What do you expect will be the greatest challenge for your business in the near future?*
How will the additional funds be utilized to support your business in the near future? Please be specific.*
Is there anything else you wish to note for our consideration?
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Please contact us at [email protected] if you have any questions or need any assistance completing this form.