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City of Faribault COVID-19 / CARES Act Small Business Relief Fund (SBRF)

  1. Tennessen Warning Notice

    Per Minnesota Statutes, section 13.04, subdivision 2, we are requesting information from you to determine if you are eligible for assistance from the City of Faribault (City). You do not have to provide the requested information, but failure to do so will result in the City’s inability to determine your eligibility for assistance. Your information will not be shared without your consent unless the law allows it or required by a court order.

  2. Disclosures*

    Check all that apply, if Applicant is unable to check all the following - Applicant is not an Eligible Entity.

  3. Applicant Contact Information

  4. Application Information

  5. Type of Business*

  6. Number of Employees*

    Number of Employees must be at least one (1) W-2 eligible employee in addition to the owner as of March 1, 2020. 1099 eligible employees will be considered for daycare providers ONLY.

  7. (Month, Year)

  8. If not applicable please note N/A

  9. Information required to demonstrate loss of revenue as a result of COVID-19.

  10. Additional Information

  11. Current status of your business?*

  12. Eligible expenses include: Rent Payments, Mortgage Payments, Utilities, Payments to Suppliers, Costs Associated with Reopening, and/or Other critical NON-PAYROLL business expenses as approved by CED and which are consistent with the intent of the Program

  13. Has your business received COVID-19 relief funding from other agencies (i.e., State of Minnesota, Rice County, etc)?*

  14. Acknowledgments*

  15. Leave This Blank:

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