Company Info

If more than one company you can just enter one of your company's names

Contact Info

Please indicate the point of contact for this service

Contact Name*

Full-Time Employee Count

Estimated Full Time Employee Count*
Average number of monthly employees for 2019 who worked over 30 hours

The full-time employee count is calculated as the the average of the monthly employees who work 30 hours or more per week during 2019.  If you need assistance with this calculation then please indicate.

Qualifications

To qualify for the credit your business must meet either of the criteria below.

-Fully or partially suspended as a result of government order, OR

-For 2020, if the business experienced a 50% reduction in quarterly receipts compared to a base period.

-For 2021, if the business experienced a 20% reduction in quarterly receipts compared to a base period.

Please indicate which qualifications you meet.

Revenue Decline
Calculated on quarterly revenue compared to same quarter in 2019
Please indicate the quarters that you had the decline indicated on the left

Government Shutdown

Full or Partial Government Mandated Shutdowns
Please indicate whether you experienced any full or partial government mandated shutdowns
Full or Partial Government Mandated Shutdown Start Date
Please indicate the start date of the mandate
Full or Partial Government Mandated Shutdown End Date
Please indicate the end date of the mandate

If your business had multiple shutdowns by the state please indicate the various dates below.  If you run out of fields then you can indicate additional dates in the comments box on the next page.

Full or Partial Government Mandated Shutdowns Additional 2
Full or Partial Government Mandated Shutdown Start Date 2
Please indicate the start date of the mandate
Full or Partial Government Mandated Shutdown End Date 2
Please indicate the end date of the mandate (if applicable)
Full or Partial Government Mandated Shutdowns Additional 3
Full or Partial Government Mandated Shutdown Start Date 3
Please indicate the start date of the mandate
Full or Partial Government Mandated Shutdown End Date 3
Please indicate the end date of the mandate

Additional Information

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