ERC Purchase Form

ERC Information

Company Info

Owner Info

Additional Owner Info

Upload Documents

DBA or Trade Name *

First Name *

Last Name *

Name of Legal Entity *

Entity Type *

EIN *

Business address, city, state, zip *

Mailing address, city, state, zip *

Business email *

Business website *

Business phone *

Date business was formed *

Please list business owners and % of ownership for anyone owning more than 20%. Guarantor ownership should equal 51% or greater.

First name *

Last name *

% Ownership *

DOB *

SS# *

VALID Government-issued photo ID# *

Issue date *

Owner’s cell phone *

Expiration date *

Owner’s email address *

Residential address, city, state, zip *

Country of citizenship *

Country of residence *

Please list business owners and % of ownership for anyone owning more than 20%. Guarantor ownership should equal 51% or greater.

First name

Last name

% Ownership

DOB

SS#

VALID Government-issued photo ID#

Issue date

Owner’s cell phone

Expiration date

Owner’s email address

Residential address, city, state, zip

Country of citizenship

Country of residence

Please list business owners and % of ownership for anyone owning more than 20%. Guarantor ownership should equal 51% or greater.

First name

Last name

% Ownership

DOB

SS#

VALID Government-issued photo ID#

Issue date

Owner’s cell phone

Expiration date

Owner’s email address

Residential address, city, state, zip

Country of citizenship

Country of residence

Please list business owners and % of ownership for anyone owning more than 20%. Guarantor ownership should equal 51% or greater.

First name

Last name

% Ownership

DOB

SS#

VALID Government-issued photo ID#

Issue date

Owner’s cell phone

Expiration date

Owner’s email address

Residential address, city, state, zip

Country of citizenship

Country of residence

IRS Form 8821 & 7216

Complete the information on pages 1 & 3. Documents must be hand-signed in black ink. The address must match the most recent IRS filing.

IRS Form 8821 & 7216 *

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Signed and dated IRS Form 941 (original return) and 941X (amended return) prepared for each quarter as submitted to the IRS.

Proof of postage will be needed if 941X’s are dated within 6 weeks.

Signed and dated IRS Form 941 (original return) and 941X (amended return) prepared for each quarter as submitted to the IRS *

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Documentation for ERC qualification (reason) from ERC filer

Eligibility reason and qualifying documentation to support from ERC preparer (revenue reduction, supply chain and government mandate/shutdown).

Documentation for ERC qualification (reason) from ERC filer *

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ERC calculations to support the ERC filing

Wage summary report broken down by employee and quarter - must match 941x filings. Confirm that PPP calculation is subtracted from ERC.

ERC calculations to support the ERC filing *

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2 most recent quarters of 941s.

2 most recent quarters of 941s. *

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Color copy of government issued ID for all owners listed on the application (front and back)

Color copy of government issued ID for all owners listed on the application (front and back) *

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Copy of 2019-2022 tax returns along with year-to-date P&L and itemized Balance Sheet

Tax Returns must include a schedule C if filed on a 1040 and K-1.

Copy of 2019-2022 tax returns along with year-to-date P&L and itemized Balance Sheet *

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Bank statements (3 Months/all pages)

Our technology partner will send you a secure link via email that will allow you to automatically transmit your bank statements required for the underwriting process.

Bank statements (3 Months/all pages) *

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