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 *

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

No

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

Yes

No

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

Terms and Conditions

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