Referring Agent

Referring Agent ID

refid

ERC Application QuickStart

Organization *

Business Address

Business City

Business State

Business Postal code

Point of Contact Full Name *

Point of Contact Title

Point of Contact Email *

Point of Contact Mobile Phone *

Authorized Signer Name *

Authorized Signer Email *

Authorized Signer Phone *

Authorized Signer Title *

Owner
President
Vice President
Chief Executive Officer
Founder
Managing Director
Managing Partner
Managing Member
Director
Principal
Administrator
General Manager
Chairperson
Director of Operations
Other
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Business Tax Type *

C Corporation

S Corporation

LLC

Multi-Member LLC

Single-Member LLC

Partnership

Sole Proprietorship

Estate

Trust

Non-Profit

Business Industry

How many full time employees (W2s issued) did you have 2021? (excluding owners and family members)

How many full time employees (W2s issued) did you have 2020? (excluding owners and family members)

Do you or any other partial business owners have ownership in any other businesses?

Yes

Was this business established before 02/15/2020? *

Yes

Additional Notes and Information

CPA Information (Optional)

This is optional. Please fill this portion out if our primary point of contact for gathering your documents will be your CPA/accountant.

CPA Name

CPA Company

CPA Phone Number

CPA Email

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