Company Name:
*
Owner Name:
*
First Name
Last Name
Business Phone Number:
*
Email:
*
example@example.com
Mobile Phone Number:
*
Website:
Business Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Legal Entity
LLC
Corporation
Sole Proprietor
Name:
First Name
Last Name
Position:
Email:
example@example.com
Phone Number:
Did your business start after 2/14/2020?
*
Yes
No
Number of Full-Time W2 employees for 2020:
*
Excluding: majority owners, family members and 1099s
Number of Full-Time W2 employees for 2021:
*
Excluding: majority owners, family members and 1099s
*Estimated Tax Credit Amount:
* This is an estimate based on the number of employees entered and does not guarantee a credit or program eligibility.
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Business description:
*
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Did your business experience a reduction in revenue at any time during 2020 or 2021? (In comparison to 2019)
*
Yes
No
Not sure
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Please check any of the following that disrupted or negatively impacted your business as a result of a government ordered mandate relating to the pandemic
*
Capacity limitations
Change in operations
Reduced business hours
Fully or partially shutdown
Inability to travel
Reduction in goods / services offered to clients
None of these
Other
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How many PPP (Payroll Protection Program) Loans did you receive?
*
1st round
2nd round
1st and 2nd round
I did not receive any PPP loans
Unsure (NOTE: we can always gather this information later)
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Who is your payroll provider?
*
ADP
Paychex
QuickBooks
Other
Do you use any accounting software such as QuickBooks?
*
Yes
No
My accountant handles that
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Name:
*
Full Name
Date:
*
Todays date
Signature:
*
Process ERC Application
Should be Empty: