Hard Hat Form Application

Business Name *

Business Website URL *

Type of Service(s) Offered, Details of the Business *

Your Name *

First

Last

Phone *

Email *

Best Way to Video Contact You *

Link to Your Facebook page *

Are You or the Business on Facebook? What is the URL to You or the Business' Page? Info is Required if This is Best Way to Contact You.

What is Your Relationship to the Business? *

What is the (1) Business Owners' Name *

What is the (1) Business Owners' Phone# *

What is the (2) Business Owners' Name

What is the (2) Business Owners' Phone#

What is the (3) Business Owners' Name

What is the (3) Business Owners' Phone#

Best Way to Video Contact the Owner(s) *

Link to Business Owner(s) Facebook Page *

Are You or the Business on Facebook? What is the URL to You or the Business' Page? Info is Required if This is Best Way to Contact You.

How Many Full Time Employees Does the Business Currently Have? *

How Many Part Time Employees Does the Business Currently Have? *

If You Have any Notes You Would Like to Add About Your Employee Count, Please Share That With Us Here. This Can Include Examples Such as that You Work with Contractors Rather Than Employees or Your Part Time Workers are Seasonal. *

Did the Business Layoff Employees Due to the Pandemic or Federal Permit Pull? *

Business Address *

Street Address / PO Box

Business Address

Apartment, Suite, Unit, Building, Floor, etc...

Business Address *

City, State, Zipcode

Does the Business Have a Valid Business License? *

How Old is the Business? *

How many months does the business have left to survive at current pace? *

How Much is the Business Losing Each Month? *

Have you previously received PPP/EIDL funding? *

Tell us your story. What is the cause of your business struggle and how would you like us to help? Share with us, and maybe the world, what makes your business valuable to the community, and the specialties you offer that makes your story unique. *

How much funding are you searching for from the Hard Hat Fund ? *

How Do You Plan to Use the Funding? *

Business Instagram handle (if applicable):

Business Twitter handle (if applicable):

Do You Have a Business Logo? *

For a business to offically be considered, a video submission is required. *

Please record and send us a video (90 seconds to 10 min max) introducing yourself, showing us the business, and describing (1) what your business does; (2) what positive impact you and your business have in your community; (3) and what you’d use your funding for and how that would help you, your business, and your community. Supported video formats (ie. MOV .MPEG4 .MP4 .AVI, mobile uploads are supported) Send to info@hardhatfund.com

Hard Hat Fund Submission Policy *

Please Read the Following: By clicking "I Accept" above, you agree to the following: - You may be asked to provide further information and documentation in support of your submission. - In consideration for the opportunity to have your submission considered as part of the Hard Hat Fund campaign, you grant Hard Hat Fund the perpetual right and license to publish, distribute, and otherwise display your name, business name, trademark, logo and video submission, and any clips, images, or portions of the video submission, in any and all media, formats and channels, in support of and in connection with the Hard Hat Fund campaign. - If your business is chosen to receive contributions as part of The Hard Hat Fund campaign, you acknowledge and agree that (i) Hard Hat Fund will have the right to make use of your business name, trademark, logo and other submitted identifiers in connection with merchandise to be sold in general support of The Hard Hat Fund (net proceeds arising therefrom will not be specifically earmarked to your business); (ii) the contributions made by Hard Hat Fund to your business will be on a one time payment and (iii) you will use any funds you receive in a manner consistent with the charitable purposes of Hard Hat Fund as defined at the time of the distribution of such funds to you. - You represent and warrant that all information, documentation and other materials you submit at any time relating to The Hard Hat Fund will be truthful and accurate and agree that a breach of the foregoing may result in the immediate rejection of your submission or the cessation of any future planned contributions to your business. - You have read and agree to Hard Hat Fund's Terms of Use [https://www.hardhatfund.com/application], the applicable terms of which govern your submission and participation in this campaign. - Hard Hat Fund will be collecting, storing and utilizing any information you provide in connection with your submission pursuant to their privacy policies which can be found here: (i) Hard Hat Fund [https://www.hardhatfund.com/application].