Rome Emergency Business Fund of the Rome Chamber, City of Rome, and Oneida County

The Chamber Executive Committee and the City of Rome will review all applications and make recommendations. Funds will be distributed in amounts from $500-$5,000 depending on need. Please complete/submit the following.

Business Name *

Affected Business Address *

Primary Business Contact Person *

Contact Person Phone Number *

Contact Person Email *

Reason For Assistance Request? (Tornado Damage) *

What Will The Funds Be Used For? *

How Much Funding Are You Requesting? *

Do You Have Insurance Coverage On The Business? *

What Are The Coverage Limits? *

Do You Have Insurance Coverage On The Building? *

What Are The Coverage Limits? *

Please provide any further information that you would like this committee to be aware of.

Affirmation and Signature

All information submitted on this application shall be kept confidential. I affirm that all information on this application is complete and true and that I have authority to submit on behalf of the applicant’s company. No information has been withheld which would affect my application unfavorably. I understand that misrepresentation can result in disqualification of my application.

Typed Signature *

Thank You For Your Submission

You will be contacted regarding your application within a week.

Rome Emergency Business Fund of the Rome Chamber, City of Rome, and Oneida County

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