Do I Qualify?

Name

Company Name

Phone

Email

Do I have 941 tax returns for each quarter of 2020 and quarters 1 through 3 of 2021 Do I have 941 tax returns for each quarter of 2020 and quarters 1 through 3 of 2021 Yes No

Have I signed and submitted a fee acknowledgement form? Have I signed and submitted a fee acknowledgement form? Yes No

Please write 2 or 3 sentences on how Covid-19 affected your business

Did you receive PPP money? Did you receive PPP money? Yes No

If Yes how much?

Did you receive forgiveness? Did you receive forgiveness? Yes No

If Yes how much?

Are you an owner? Are you an owner? Yes No

Please list all Owners and their percentage of ownership

Did any owners have immediate family who received W2 wages Did any owners have immediate family who received W2 wages Yes No

Please list all Owners family members that received W2 wages