ERC Application Form

This authorizes ERC Collection, Inc. to process Employee Retention Credits ("ERC") for 2020 and 2021 and refile payroll tax returns as needed.

Client Info

Contact First Name

Contact Last Name

Contact Title

Company

Contact Phone

Contact Email

Legal Business Name

EIN/Tax ID Number

Date of Incorporation

State where busines is incorporated

Estimated amount of Employees during 2020?

Estimated amount of Employees during 2021?

How many PPP loans have you received?

Do you have other businesses? If so, list Name of Business, Email, and Phone Number

ERC Qualifying Information

Which of the following (if any) qualifies Company for Employee Retention Credit for 2020 and 2021?

Did you have any modifications during your operation due to government shutdowns and restrictions?

Did your company go through a full or partial suspension of the operation of their trade or business during this period because of governmental shutdown due to COVID-19?

A decline in gross receipts in a calendar quarter in 2020 and 2021 where the gross receipts of that calendar quarter

Did you use a payroll company to process your payroll in 2020 and 2021? If so, please give the name, phone number, and email contact of the company?

Have you processed Employee Retention Credits with anyone other than ERC Collection, Inc. for 2020 or 2021?

How many full time employees did employ in 2020?

How many full time employees did employ in 2021?

Best time of the day to contact you?

Would you like to refer someone? (Optional)

Referal Name

Phone Number

Upload your documents

Please provide and upload the following documents.

941 Documents
Payroll records by employee by quarter (These records should reflect full time employees)

*** Excel & PDF documents preferable

Click or Drag File to Upload

By clicking submit, I acknowledge I am an authorized owner or officer of company and authorized to make tax decisions. I also confirm that the above information is correct and true to the best of my knowledge. Fees for this service will be determined and agreed upon before work begins. I authorize ERC Collection, Inc to process Employee Retention Credits (ERC) based on the data above and the current understanding of ERC guidance by the IRS. ERC for 2020 and 2021 will be calculated based on the data above. Neither ERC Collection, Inc. or Lubell Rosen, LLC shall be responsible to verify data. Liability for ERC against ERC Collection, Inc. or Lubell Rosen, LLC is limited to fees charged for ERC services. All fees for this service are due ten days after receipt of ERC funds. If no funds are recovered, there are no fees.