Your name(Required) First Last Your Email(Required) Your TitleDo you currently work with a CPA, Accountant, or Bookkeeper?(Required) Yes No Can we work with them to gather your documents? Yes No CPA, Accountant, or Bookkeeper NameCPA, Accountant, or Bookkeeper EmailCPA, Accountant, or Bookkeeper Phone #Your Company Name(Required)Do you have a qualified retirement plan set up through your business?(Required) Yes No Type of retirement plan(Required)401(k)SEP IRASimple IRAOtherCompany Address (physical location)(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Was your business operational in 2018?(Required) Yes No Please state first date of operation/first date of revenue, whichever is later.(Required)Have you filed for the ERC previously for this business?(Required) Yes No Please list the year(s) and quarter(s) and include these 941xs in your submission.(Required)Did you receive a PPP Loan?(Required) Yes No How many PPP Loans did you receive? 1 2 3+ How many were forgiven? 0 1 2 3+ Did ownership of your business change during 2020 or 2021?(Required) Yes No Please provide the month and year in which ownership changed.Did you purchase or sell the business? I purchased the business I sold the business Please provide a copy of the sales agreement to your Process Manager. Was the business sold through an entity or asset sale? Entity Sale Asset Sale I don't know For the company for which you are applying for an ERC, list any owners on the employee payroll who own more than 50% of the company:(Required)Do you own 80% or more of the company?(Required) Yes No Do you own a second company? Yes No Do 5 or less people own 80% or more of the company? Yes No Do you own this second company with the owners associated with the first company? Yes No Do those same 5 or less people own any other businesses together in any combination? Yes No Please list the Name of the Second Business, Owners Name, and % Ownership for each of these overlapping ownerships. (Note: You may add additional rows, as needed, with the + Button on the end of the row) Add RemovePlease list the name of the additional businesses, Owners Name, and % Ownership for each of these overlapping ownerships. (Note: You may add additional rows, as needed, with the + Button on the end of the row) Add RemoveDo you own any other businesses (a third, fourth, fifth, etc) in which you own at least 80%? Yes No Do you own any other businesses (a third, fourth, fifth, etc) in which you own at least 80%? Yes No Do you own any other businesses (a third, fourth, fifth, etc) in which you own at least 80%? Yes No Do you own any other businesses (a third, fourth, fifth, etc) in which you own at least 80%? Yes No Please list the name of the additional businesses, Owners Name, and % Ownership for each of these overlapping ownerships. (Note: You may add additional rows, as needed, with the + Button on the end of the row) Add RemovePlease list the name of the additional businesses, Owners Name, and % Ownership for each of these overlapping ownerships. (Note: You may add additional rows, as needed, with the + Button on the end of the row) Add RemovePlease list the name of the additional businesses, Owners Name, and % Ownership for each of these overlapping ownerships. (Note: You may add additional rows, as needed, with the + Button on the end of the row) Add RemovePlease list the name of the additional businesses, the owners names, and % of ownership. (Note: You may add additional rows, as needed, with the + Button on the end of the row) Add RemovePayroll Information Do any of the owners with more than 50% ownership have any immediate or extended family members on payroll? If yes, please list them by name (spelled exactly as they are listed on the payroll summaries):(Required)What software do you use to process payroll? (e.g. ADP, Paychex, Intuit QB, none)(Required)Does your company utilize a PEO (Professional Employer Organization - outsourced HR)?(Required) Yes No Please provide the PEO contact namePEO contact phonePEO EmailDo you offer healthcare to your employees and incur costs?(Required) Yes No Do you offer retirement plans (i.e. 401k) to your employees and incur costs?(Required) Yes No Business Demographics Is your business considered an essential business?Essential business definition is state-by-state and not set at the federal level. Yes No Please give us a brief summary of your business operations.(Required)Approximate number of Full-Time Employee Count*The term "full-time employee" means an employee who, with respect to any calendar month in 2019, had an average of at least 30 hours of service per week or 130 hours of service in the month (130 hours of service in a month is treated as the monthly equivalent of at least 30 hours of service per week), as determined in accordance with section 4980H of the Internal Revenue Code. An employer that operated its business for the entire 2019 calendar year determines the number of its full-time employees by taking the sum of the number of full-time employees in each calendar month in 2019 and dividing that number by 12.in 2019:(Required)in 2020:(Required)in 2021:(Required)Travel Impact Did you have to travel out of state to continue business operations in 2020 and/or 2021?(Required) Yes No Please explain out of state travel circumstances(Required)Is there any travel that your business ordinarily would have been done in 2019 but was changed to virtual or did not occur in 2020 and/or 2021?(Required) Yes No Please describe the impact to your business operations(Required)Is there any travel that your business ordinarily would have done in 2020/2021 that did not occur due to governmental restrictions limiting travel/events?(Required) Yes No Please explain how restrictions affected business operations(Required)Does your business depend on trade shows to generate new revenue?(Required) Yes No Operational ImpactIn what cities and states does your business have operations? Please list the city and state your offices, retail stores, and /or warehouses are located and a quick summary of the type of business conducted at each.(Required)Did your company close any office, retail and/or warehouse locations to comply with governmental orders related to COVID? For example, a “Stay Home, Stay Safe, Stay Healthy” order?(Required) Yes No Please describe and list year and quarter(s) impacted.(Required)Did your company close “and/or reduce capacity”?(Required) Yes No Please describe and list year and quarter(s) impacted.(Required)Customer ImpactList any cities and states your clients travel FROM to conduct business with you.(Required)Did any customers close operations or reduce operations as a result of COVID orders?(Required) Yes No Please describe:(Required)Please describe how customer interactions changed as a result of COVID. (ex: if you are a restaurant and shut down part of your facility and moved to take-out, or a real estate firm that went to virtual tours of properties).(Required)Were any projects or timelines impacted?(Required) Yes No Please describe:(Required)Supplier ImpactDid any suppliers have difficulty getting raw materials or goods to you as a result of COVID?(Required) Yes No Please list your suppliers, the city and state where they are located, and list the raw materials/goods impacted.(Required)Did your company source raw materials or goods from China or any other countries impacted by travel restrictions?(Required) Yes No Please list the raw materials/goods impacted. Note: This can be used as a business sector in the attached worksheet to show revenue amounts impacted.(Required)List Add Remove
