Employee Retention Credit Form.Do you qualify? Name * First Name Last Name Title * Email * Phone * (###) ### #### Business Address * Address 1 Address 2 City State/Province Zip/Postal Code Country When did you start your business? * Before February 15th, 2020 On or after February 15th, 2020 Did You Have W-2 employees on Payroll during 2020 and 2021? * Yes during both years Just 2020 Just 2021 No (does not qualify) How many W-2 Employees did you have in 2020? * 1-50 51-100 101-499 500+ (Does not qualify) How many W-2 Employees did you have in 2021? * 1-50 51-100 101-499 500+ (Does not qualify) Were there any employees related to any owner(s)/shareholder(s) of the company? * Yes No Was your business negatively impacted by a government imposed order or capacity restriction? * Yes No Did you experience revenue loss during 2020 or 2021 compared to 2019? * Yes No Did you receive any PPP loan(s)? * Yes No Thank you! We will review this information and get back to you as soon as possible.
