ERC Tax Credit Form

Qualifying Questions

If you have multiple companies to qualify, please input and qualify each company separately.

Note: This is for estimation purposes only. The actual credit is based on the documents submitted. Potential ERC amount is based on the average count qualifying for all 6 quarters of the ERC program.

Name

Email Address

Phone

Company

Total Employees in 2020

Total Employees in 2021

50% Quarterly Decline in 2020 Gross Receipts 50% Quarterly Decline in 2020 Gross Receipts Yes No

50% Quarterly Decline in 2021 Gross Receipts 50% Quarterly Decline in 2021 Gross Receipts Yes No

Impacted by a Government Order Impacted by a Government Order Yes No

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