Lead Intake Form

1
In what year did the business begin operating?* This field is required.
2
How many unique W2 employees did you have on payroll during the pandemic?* This field is required.Exclude owners and relatives of owners.
In 2019
In 2020
In 2021
3
eligibility_2020
4
eligibility_2021
5
Compared to 2019, did your business experience a year-over-year revenue decrease for any quarters of 2020 or 2021?* This field is required.You can determine this from your 2019-2021 Quarterly Income Statements
Please Select
Please Select
Yes
No
N/A - Business was not operating yet
In 2020
Please Select
Please Select
Yes
No
N/A - Business was not operating yet
In 2021
6
In 2020 or 2021 were your operations affected by a government-mandated slowdown or shutdown, or a disruption caused by a supplier's or partner’s shutdown?* This field is required.
Please Select
Please Select
Yes
No
In 2020
Please Select
Please Select
Yes
No
In 2021
7
estimate* This field is required.
8
You may be eligible for the Employee Retention Credit! Based on your answers you could qualify for up to ${estimate}.

Please take 5 minutes to provide some additional information that will help us assess your ERC eligibility. This is free & confidential, and won’t impact your credit.
9
First, please tell us about yourself. Then we’ll ask a few more questions about your business.Your responses will be kept confidential and will not be shared without your consent
First name
Last name
Phone number
Email
10
What is the name of your business entity?
Name registered with the Secretary of State
DBA (if applicable)
11
What industry is your business in?* This field is required.For example: Restaurant, Construction, Manufacturing, Travel, Medical Services.
12
What is the business entity type?* This field is required.
Sole-Proprietorship
Partnership (GP, LP, LLP, LLLP)
LLC
S-Corp
C-Corp
Nonprofit
Other
13
Are you taxed as an S-Corp?
YESNO
14
How many people have 5% or more ownership in the businesses?* This field is required.
15
Do any majority owners (or a group comprising more than 50% ownership) have more than 50% ownership in any other businesses?Please briefly explain
16
How did the current owner(s) come to own the business?* This field is required.
Started the company
Acquired the company (asset purchase)
Acquired the company (equity purchase)
Other
17
What is the location where most of your employees work?* This field is required.
Adress
Address line 2
City/Town
Please Select
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
State/Region/Province
Zip/Post Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
18
During 2020-2021 how did you run your payroll?* This field is required.If you switched payroll systems between 2019 and 2021, please select all that apply
We ran payroll in house
ADP
Intuit QuickBooks
Paychex
Paylocity
Other
19
Did you use a PEO (Professional Employer Organization) in either 2020 or 2021?* This field is required.PEOs have a co-employment arrangement and typically provide support services for HR, Benefits, and Risk Management
I don't know
No
Other
20
Which of the following did you provide for employees in 2020 or 2021?Please select all that apply
Health Plan
Retirement Plan
21
Please describe your slowdowns, shutdowns, or supply-chain disruptions during 2020-2021. Were you forced to suspend some of your operations due to government orders, or was it voluntary? How long did it last, and what was the impact on your business?
22
If you took PPP loans, how much was forgiven as "payroll costs"?Leave blank if you did not take a PPP loan that was forgiven
2020 ("Round 1")
2021 ("Round 2")
23
Did you receive any other pandemic-related grants or government benefits, such as the Restaurant Revitalization Fund (RRF) grant or the Shuttered Venue Operator Grant (SVOG)?Please include amounts
Huge
Large
Normal
Small
Ok
Ok
24
Are you or your business currently in Review or Audit by the IRS? Do you owe money to the IRS?This doesn't disqualify you. Informing us of IRS issues you're working through will help us navigate through any potential complications with your ERC filing.
Huge
Large
Normal
Small
Ok
Ok
25
Almost done! Is there anything you'd like to add that we haven't asked? Do you have questions for us?
26
Last question: Did someone refer you to us?We don't advertise or cold-call. Instead, happy clients fuel our business. If someone you know recommended us, please let us know:
Individual Name
Company Name
27

We'll be in touch soon!
28

Thank you.

That gives us with enough information to provide an initial assessment of your ERC eligibility.
Should be Empty: