Economic Impact CARB Survey

1. Are you an Owner-Operator? Required Question

	Yes
	No

2. Have you reduced the number of trucks in your fleet in 2008 and 2009? If so

2008
2009

3. If an employer, how many employees have you laid off in 2008 and 2009?

2008
2009

4. What was your approximate gross revenue in

2007
2008
Projects for 2009

5. If your equipment is financed, are you having difficulty making payments on your vehicles due to lack of work?

	Yes
	No

6. Can we contact you for more information, if needed?
If so, please fill in name and number of key person in company?

First Name

Last Name

Title

Company Name

Street Address

Apt/Suite/Office

City

State

Postal Code

Email Address

Phone Number

Fax Number

Mobile Phone

7. Please use space below if you wish to share the hardships the current recession has had on your business and family, such as bankruptcy, equipment repossession, home foreclosure, loss of medical insurance, etc.