ERTC – Employee Retention Tax Credit Form (Sales Support) Please fill out the following questions to continue with the application process. Step 1 of 8 12% About YouYour Name First Last Your PhoneYour Email Address Email Address Confirm Email Address EthnicitySelect…American Indian or Alaska NativeArabAsianBlack or African AmericanHispanic or LatinoNative Hawaiian or Other Pacific IslanderWhitePreferred LanguageSelect…EnglishSpanishOther About your businessHiddenAffiliate Business Name Employer Identification Number (EIN)Please enter a number from 000000001 to 999999999.Do not add dashesAddress Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Business Started Date Month Day Year Enter ‘1’ in the day field if you’re unsure about the business’s start date.IndustrySelect…Accommodation and food servicesAgriculture and farmingArts, entertainment, and recreationConstructionEducational servicesFinance and insuranceHealthcare and social assistanceInformation technology and telecommunicationsManufacturingMining and quarryingOther servicesProfessional, scientific, and technical servicesReal estate and rental and leasingTransportation and logisticsWholesale and retail tradeSpecializationSelect…Accounting and bookkeeping servicesAdvertising and public relations servicesAir transportationAmbulatory healthcare services (e.g. doctors' offices, outpatient care centers)Aquaculture (e.g. fish farming)BankingCatering servicesChemical manufacturingCleanning ServicesCoal miningColleges, universities, and professional schoolsComputer systems design and related servicesCrop production (e.g. grains, fruits, vegetables)Electronic and computer manufacturingElementary and secondary schoolsEngineering servicesEquipment rental and leasingFlooringFood and beverage manufacturingForestry and loggingHeavy and civil engineering construction (e.g. bridges, highways, tunnels)HospitalsHotels and motelsInsurance carriers and related activitiesLandscapingLegal servicesLivestock production (e.g. cattle, poultry, dairy)Machinery manufacturingMetal ore miningMuseums, historical sites, and similar institutionsNonmetallic mineral mining and quarrying (e.g. stone, sand, clay)Nonresidential building constructionNonresidential property leasing and managementOther educational services (e.g. language schools, tutoring services)Performing arts companiesProfessional MakeupRail transportationResidential building constructionResidential property leasing and managementRestaurants and other food servicesRetail trade (e.g. department stores, supermarkets, online retail)Securities, commodity contracts, and other financial investmentsSocial assistance services (e.g. childcare, family services, elderly and disabled services)Spectator sportsTelecommunications carriers and related servicesTextile and clothing manufacturingTruck transportationWarehousing and storageWater transportationWholesale trade (e.g. wholesale of durable goods, and nondurable goods)Owner Name 1 Ownership % – Owner 1Please enter a number from 0 to 100.Owner Name 2 Ownership % – Owner 2Please enter a number from 0 to 100.Owner Name 3 Ownership % – Owner 3Please enter a number from 0 to 100.Owner Name 4 Ownership % – Owner 4Please enter a number from 0 to 100.Owner Name 5 Ownership % – Owner 5Please enter a number from 0 to 100.Owner Name 6 Ownership % – Owner 6Please enter a number from 0 to 100. Family members in payrollDid the majority owners have family members on the payroll?Select…YesNoDid any owner with 50% or more of ownership have any family members on the payroll?Employees Names *For multiple employee please separe them with a comma (,)Relation *For multiple employees please separe their relation with a comma (,) in the same order as previous question.Related to what owner? *For multiple employees please separe their relation with a comma (,) in the same order as previous question. PPP LoansPlease add the PPP loan information, if you applied for a PPP loan.Did you apply for PPP loan? Yes No PPP Round 1 AmmountPPP Round 1 Disbursement Date MM slash DD slash YYYY Was it forgiven?Select…YesNoPPP Round 2 AmmountPPP Round 2 Disbursement Date MM slash DD slash YYYY Was it forgiven?Select…YesNoUpload PPP forgiveness if availableMax. file size: 50 MB. If you're a restaurant company, did you receive Restaurant Revitalization Fund?Select…YesNo Number of EmployeesAnnual average paid on Payroll (W-2)Anual Revenue (USD)Select…0 – 500k500K – 1M1M – 3M3M – 5MMore than 5MNumber of SubcontractorsAnnual average paid to Subcontractors (1099) Documents UploadPlease upload the following documents. You can upload multiple files per field.Monthly Gross Receipts/Monthly Revenues Drop files here or Select files Max. file size: 50 MB. You can upload multiple files. PDF,XLS and XLSX.Payroll Detailed By Employee Per Month Drop files here or Select files Max. file size: 50 MB. You can upload multiple files. PDF,XLS and XLSX.Business Federal Tax Returns (2019 – 2021) Drop files here or Select files Max. file size: 50 MB. You can upload multiple files. PDF,XLS and XLSX.941 Forms (2020 – 2021) Drop files here or Select files Max. file size: 50 MB. 941 Quarterly Tax Reports You can upload multiple files. PDF,XLS and XLSX.