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ERC
Client Questionnaire
Part 1: Company Information
Business Name (Legal Entity Name)
Trade Name
EIN#
Business Street Address
Business City
Business State
Business Zip Code
Phone
Email
Business Description/Industry
Owner #1
Ownership %
Owner #2
Ownership %
Owner #3
Ownership %
Payroll Provider
Please Select
If "Other"
How Many W2 Employees?
Do any employees have Employee Pre-Tax Health expenses deducted from their gross wages?
*
Yes
No
Part 2: PPP and Other Information
Did you take a 1st Draw PPP Loan? (If "Yes" how much?)
*
Yes
No
If "Yes", how much?
Provide the date received of Loan 1
Percentage of Loan used for Payroll:
Did you take a 2nd Draw PPP Loan? (If "Yes" how much?)
*
Yes
No
If "Yes", how much?
Provide the date received of Loan 1
Percentage of Loan used for Payroll:
Please explain specifically how your business may have been affected during the Covid-19 pandemic. (Examples: Temporary shutdowns, slow downs, capacity limits, supply chain issues, social distancing, travel mandates, hiring issues, etc.)
Was your business considered "essential" and deemed allowed to maintain all operations?
Yes
No
Part 3: Startup Companies Only
Did your company start after February 15th 2020?
Yes
No
Are total gross receipts for the 3-taxable-year under $1,000,000?
Yes
No
Submit
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