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Commercial COVID Questionaire

Borrower Name 

Account Number 

Phone Number 


CNB Bank Office Preferred 

Relationship Manager 

Month Deferral Options  

1.  How is your business currently impacted by the Coronavirus?


2. Over the next 90 days, how much negative cash flow or revenue impact will your business incur?

 Please provide answer as a percentage(%)



3. Do you currently have International customers or current sales prospects that you are working with?

Do they represent more than 10%-15% of sales?



4. Does your business have suppliers outside the country?

 If so, do they supply more than 10-15% of your needs?



5. Would it be difficult to immediately source alternative suppliers if needed?



6. Have any of your employees been quarantined or impacted from the Coronavirus?



7. Have you or any key employees traveled outside the United States in the last 30-45 days?



8. Have you implemented any policies or procedures involving restricted travel to other states, countries, national conferences, business meetings, etc.?



9. Could your business revenue be significantly impacted due to concentrations to industries already impacted by the Coronavirus such as hospitality, auto, retail, food and beverage?



10. What is your contingency plan in the event your company/employees are impacted by Coronavirus?



Completion of this form does not guarantee a deferment.

This form is to help identify customers that qualify for our Commercial Loan Deferment Program for total credit less than $500,000 and have a direct impact as a result of the coronavirus pandemic.

Direct impact may be defined as challenges in any of the following areas: Employees, Supply Chain, Customers, and/or Legislative Impact that is resulting in cashflow and liquidity challenges.

This form provides us with the background necessary for us to be prepared for further discussions with our customers about their needs for short and/or long-term.

Upon completion and submission of the completed form, you will be contacted by your Relationship Manager.

Thank you.