ORIGINAL_Employee Retention Credit

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Get Started with the Employee Retention Credit

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Get Started with the Employee Retention Credit

Company Legal Name:

Company DBA (if applicable):

Your Name:

Your relationship to the company:

Your Telephone Number:

Your Email Address:

List all company owners and percentages:

Was your business fully or partially suspended by government order due to COVID-19 during any calendar quarter in 2020 or 2021?

If yes, provide the approximate date range(s):

2019 gross receipts Q1:

2019 gross receipts Q2:

2019 gross receipts Q3:

2019 gross receipts Q4:

2020 gross receipts Q1:

2020 gross receipts Q2:

2020 gross receipts Q3:

2020 gross receipts Q4:

Total number of employees in 2019 (do not include owners):

Total number of employees in 2020 (do not include owners):

Gross payroll paid in 2020 for all employees and owners:

Gross payroll paid in 2020 (owners only):

Company paid health insurance paid in 2020 for all employees and owners:

Company paid health insurance paid in 2020 (owners only):

Did your business receive a Paycheck Protection Program Round 1 loan?

If Yes, how much?

Did you (or do you expect to) receive a Paycheck Protection Program Round 2 loan?

If Yes, how much?

What is the name of your payroll company?

What is the name of your accounting company?

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Grandjean, Wagner, Beiter & Company is dedicated to supporting clients during all stages of their individual business and personal financial journey, no matter how big or small.

Tel: (315) 432-9865

Fax: (315) 432-9866

6690 Hammersmith Drive

East Syracuse, NY 13057

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