Official ERC Application

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This questionnaire will help you in determining whether you are eligible to claim ERC. The
questionnaire and ERC Fulfillment do not make determinations as to whether you are eligible for ERC.
Your honesty and accuracy are especially important when it comes to any difficulties or restrictions your
business faced during the COVID-19 pandemic.
Name
N/A

Required First Name Required Last Name
Email *
N/A
Phone *
N/A
Company *
N/A
Number of W2 employees in 2020 & 2021? (estimated) *
N/A
Please indicate if you are 51% or more ownership in the company or if you have a partnership of 50% ownership or less. *
N/A

51% Ownership or more
Partnership of 50% or less
Please list any family member who was on payroll in 2020 or 2021.
N/A
When was the company started? *
N/A

Before February 15th 2020
After February 15th 2020
Referral Source (Optional)
N/A
Did supply chain issues cause more than a nominal impact (>10%) on your business sales or labor hours?
N/A

Yes
No
In which quarters of 2020 did the supply chain impact occur (meaning you were NOT able to find a reasonable replacement)? Skip if you were not affected in any quarter of 2020.
N/A
In which quarters of 2021 did the supply chain impact occur (meaning you were NOT able to find a reasonable replacement)? Skip if you were not affected in any quarter of 2021.
N/A
Did you experience a full or partial suspension due to a COVID government order? Check all that apply.
N/A
Which quarters you were impacted for 2020?
N/A
Which quarters you were impacted for 2021?
N/A
Did you experience a gross revenue loss of 50% or more in 2020 (in either Q2, Q3 or Q4) compared to the same respective quarters in 2019?
N/A

Yes
No
In which quarters did your company experience the 50% gross revenue loss in 2020 compared to 2019? Please check all that apply.
N/A
Did you experience a gross revenue loss of 20% or more in 2021 (in either Q1, Q2, or Q3) compared to the same respective quarters in 2019?
N/A

Yes
No
In which quarters did your company experience the 20% gross revenue loss in 2021 compared to 2019? Please check all that apply.
N/A
If you received a PPP loan please enter the dollar amount received.
N/A
Enter Received Date of PPP:
N/A

dd-MMM-yyyy
Upload Supporting Documents
Q2 2020 941 Tax Forms
N/A
Upload file
Q2 2020 Payroll Reports
N/A
Upload file
Q3 2020 941 Tax Forms
N/A
Upload file
Q3 2020 Payroll Reports
N/A
Upload file
Q4 2020 941 Tax Forms
N/A
Upload file
Q4 2020 Payroll Reports
N/A
Upload file
Q1 2021 941 Tax Forms
N/A
Upload file
Q1 2021 Payroll Reports
N/A
Upload file
Q2 2021 941 Tax Forms
N/A
Upload file
Q2 2021 Payroll Reports
N/A
Upload file
Q3 2021 941 Tax Forms
N/A
Upload file
Q3 2021 Payroll Reports
N/A
Upload file
PPP Forgiveness Application (3508S)
N/A
Upload file

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