ERC Data Request Questionnaire v2

Your Name*

First NameLast Name

Employee Title*

Will you be the point of contact for the ERC data collection?*

YESNO

Name of Point of Contact

Email of point of Contact

example@example.com

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

Business Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry

Is the business address above the address the ERC refund checks should be mailed to/the address on file with the IRS?

YesNo

Legal Business Name*

Mailing Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry

Entity Type*

Did you receive government grants/funding in 2020 or 2021 that are allocated towards payroll?

YesNo

EIN / Tax ID #*

When did you start your business?

Before February 15, 2020After February 15, 2020

Date of Incorporation*

Date

Was this business part of an acquisition or a startup?

YesNo

Please briefly describe your trade or business

Please select all of the US States that represents at least 10% of your operations. (Revenue and or Payroll)

Does your business operate in the five Boroughs? (Bronx, Brooklyn, Manhattan, Queens, Staten Island)*

YESNO

Have you filed for the Employee Retention Credit for any quarters in 2020 or 2021?*

YESNO

What quarters have you filed for the Employee Retention Credit?*

How many total companies does the majority owner of the business own?*

Is this business part of a larger organizational structure? (Example: Has a Parent Company, Subsidiary Companies or Private Equity Owned.)*

YESNO

Is there more than one entity applying (or plan to apply) for ERC?*

YESNO

Other Business's Name

Was the business(s) considered an essential business throughout the COVID-19 Pandemic?*

YesNo

What is the name of the person that owns more than 50%?

Did the business have a nonessential portion of the business? if so, please describe the nonessential portion:

ERC Data Request Questionnaire

Payroll Details

# of Employees (Critical Information)

PPP Details

Billing Details