Second Look Business Tax Credit - Interest Form
Please fill out all the information and then a Representative will contact you shortly.
Personal Information:
Date
/
Month
/
Day
Year
Date
Referral
Name
Mr.
Mrs.
Prefix
First Name
Last Name
Phone Number
Personal Email
example@example.com
Select Your Type of Business:
Startup and/or Growing Small Businesses - No profit
Low-Profit or Break-Even Businesses - Minimal profit
Established Businesses - Profit
N/A
Which best describes you?
No Taxes Filed
Head of Household (HOH)
Married Filing Jointly (MFJ ) (*Even if only one had income)
Married Filing Separately (MFS)
Qualifying Surviving Spouse (QSS)
Name of Spouse
Select your current tax situation for 2021:
No Taxes Filed
Personal Taxes Filed, Business Taxes Not Filed
Business Taxes Filed, Personal Taxes Not Filed
Both Personal and Business Taxes Filed
Select your current tax situation for 2022:
No Taxes Filed
Personal Taxes Filed, Business Taxes Not Filed
Business Taxes Filed, Personal Taxes Not Filed
Both Personal and Business Taxes Filed
Select your current tax situation for 2023:
No Taxes Filed
Personal Taxes Filed, Business Taxes Not Filed
Business Taxes Filed, Personal Taxes Not Filed
Both Personal and Business Taxes Filed
Do you have a health insurance?
Yes
No
Do you have a life insurance?
Yes
No
Submit
Should be Empty: