ERC Benefits Application-Elgin
Business Name
*
First Name
*
Last Name
*
Email
*
Phone
*
Business/Industry
*
Please Select
Attorney
Church/House of Worship
Construction
Fitness/Gym
Hospitality (Hotel, Travel)
Medical (Doctor, Dentist, etc.)
Other
Personal Care(hair salon, nail salon, massage, etc)
Restaurant/Bar
Staffing
Please select "Other" if your business type is not listed below.
Where is your business located?
*
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
When did your business open?
*
On or After 2/15/2020
Before 2/15/2020
Year of Opening:
Please Select
2020
2021
Month of Opening:
Please Select
January
February
March
April
May
June
July
August
September
October
November
December
How did you hear about us?
How many W-2's were issued for 2020?
*
You must have retained a minimum of three W-2 employees to qualify for our services.
How many W-2's were issued for 2021?
*
You must have retained a minimum of three W-2 employees to qualify for our services.
Do you or any other partial business owners have ownership in any other businesses?
*
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Date
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Month
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Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
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