REQUEST FOR DESIGNATION AS AN ESSENTIAL BUSINESS FOR PURPOSES OF EXECUTIVE ORDER 202.6

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Request for clarification or consideration as an essential business for purposes of Executive Order 202.6

Please note: ONLY businesses who have determined that they are NOT essential under the guidance should complete this form. Businesses that have determined that they are essential should NOT complete this form.

Name of Business

NAICS Code

For information on finding your organization's NAICS code, please see: https://www.tax.ny.gov/pubs_and_bulls/tg_bulletins/st/naics.htm.

First Name of Contact Person

Last Name of Contact Person

Phone Number

Email Address

Address of Business Location Seeking Designation

City

State

Zip Code

County

ESD Region

Number Of Employees At Location

Description Of Business Function At Location Seeking Designation

Industry

I am requesting that my business be deemed an Essential Business for purposes of Executive Order 202.6 for the reasons listed below.

Provide A Brief Description Below

I certify by penalty of perjury that the information that I have provided herein is true and accurate.

Name Of Authorized Applicant

Request for clarification or consideration as an essential business for purposes of Executive Order 202.6

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