First Name
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Last Name
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Email
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Phone
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Street Address
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City
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State
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Postal code
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EIN Number/Tax ID
What is your Business Entity Type?
Business Entity Type
What is the legal name of your business?
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Did your business start before 2020?
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Yes or NO
Has your business previously received or applied for any Employee Retention Credit? (multiple choice)
Yes or No
How many W-2 employees did your business have in 2020?
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How many W-2 employees did your business have in 2021?
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If you have a payroll processer, who is it?
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If applicable, who has access to your payroll processing account?
If your business has a majority owner, do they own any other businesses?
Yes or No
Comments
Agent Name