Employer Retention Tax Credit Form

Website
Source
Employer Retention Tax Credit Form
Name *

First Name Last Name
Business name *
Email *
example@example.com
Phone Number *
Please enter a valid phone number.
Accountant or partner that referred you
How many employees do you have on payroll that receive a W2?
Include both part time and full-time employees.
How many of the W2 employees entered in the previous question are related to the owner?
Related individuals include the following: child or a descendant of a child, brother, sister, stepbrother, or stepsister; father or mother, or an ancestor of either; stepfather or stepmother; niece or nephew; aunt or uncle; son-in-law, daughter-in-law, father-in-law, mother-in-law, brother-in-law, or sister-in-law.
What is the NAICS code for the business?
What zip code(s) does your business operate in?
What industry does your business operate in or what type of service do you provide?

Enter gross receipts for the following quarters:

Have you received a PPP loan? either 1 or 2

Yes No
What was the amount of the PPP loan received?
What day did you receive the funds from the PPP loan?

Month Day Year
Date
Have you applied for forgiveness for the PPP loan?

Yes No
Please provide the login details for your payroll provider if you have one.

Username Password
Do you provide grouphealth benefits to your employees
Do you or any other owner of the business own any other businesses?
Where is your business located?

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Should be Empty: