ERC Intake Form
Phone
Name
Name
First
First
Last
Last
Email
Address
Address
Address
Address
City
City
State
Alabama
Alaska
Arkansas
Arizona
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip
Zip
In 2020 or 2021 did you have more then THREE W2 Employees?
Yes
No
Applied for PPL in the past?
Yes
No
Denied PPL in the past?
Yes
No
DID YOU EXPERIENCE A 20% OR GREAT DROP IN REVENUE IN QUARTER 1 OF 2021 COMPARED TO QUARTER 1 OF 2019?
Yes
No
DID YOU EXPERIENCE A 20% OR GREAT DROP IN REVENUE IN QUARTER 2 OF 2021 COMPARED TO QUARTER 2 OF 2019?
Yes
No
IS THE COMPANY STILL OPEN AND OPERATING?
Yes
No
ROUGHLY HOW MUCH DO YOUR EMPLOYEES TAKE HOME PER YEAR?
If you are human, leave this field blank.
Submit