EmailMe Form - Get Relief Covid-19 - Small Business Intake Form

EmailMeForm

CONTACT INFO
This section you will provide contact information for the business.
Company Name *
Industry *
EIN (Employee Identification Number) *
State TID Number
File Upload - Upload a copy of your EIN verification, Articles of Incorporation, and State TID if available

Add File
Was your business in operation on or before January 31, 2020? *
Yes
No
Was your business in operation on or before January 31, 2019? *
Yes
No
Have you had to close your business due to the COVID-19 pandemic? *
Yes
No
How many employees does your company have currently?(this does not include contractors) *
How many employees did your company have in 2020?(this does not include contractors) *
How many employees did your company have in 2019?(this does not include contractors) *
Have you had to let go staff due to the COVID-19 pandemic? *
Yes
No
Have you had to scale back operations of your business due to the COVID-19 pandemic? *
Yes
No
What type of business do you offer *
Provide Services
Sell Goods
Both
Primary Business Contact Name (1) *
First Last
Title/Position *
Social Security Number
Primary Business Contact Name (2) *
First Last
Title/Position *
Social Security Number *
What was your total gross revenue for 2019? *
What was your total gross revenue for January 1-31, 2020? *
Business Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Physical Address no P.O. Boxes
Phone *
### - ### - ####
Email *
Fax
Services
Please select other services that you are interested in. Check all that apply.
Choose all that may apply *
PPP Loan (1st Draw)
PPP Loan (2nd Draw)
PPP Forgiveness
EIDL (Economic Impact Disaster Loan)
Tax Preparation
Bookkeeping
Payroll Management
Legal Services (Legal Shield)
Business Coaching(Start Ups)
Business Consulting
BUSINESS STRUCTURE INFO
A description of the section goes here.
Business Structure (Choose One) *
Sole Proprietor
Single Member LLC
LLC (multi-member)
Partnership
S Corp (Single Member)
S Corp
C Corporation
501(c)(3)
Personal Services Corporation
List the owners of the business and their title/role and percentage of ownership. *

Owner/Partner 1

Owner/Partner 2

Owner/Partner 3

Owner/Partner 4

If there is only 1 owner please put n/a in the other fields.

Example: John Doe, President, 50%
Do you pay the following? *
Employees (W2)
Contractors (1099)
None of the above
Fiscal Year Starting month (type CALENDAR if January-December)
Fiscal Year Ending month (type CALENDAR if January-December)
Taxes
Please fill out this section.
Have you filed your current year personal tax return? *
Yes
No
Have you filed your current year business tax return? *
Yes
No
Do you need to file your personal taxes? If so check the boxes below that apply *
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
Do you need to file your business taxes? If so check the boxes below that apply *
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
Do you have proof of income for your business? If so check the boxes below that apply *
Receipts
Bank Statements
Invoices/Purcahse Orders
1099-Miscellaneous
1099-K
Spreadsheet
Electronic bookkeeping system (Quickbooks, Wave, other)
Written down on paper
I do not have the proof of income available
How much income did your business make in 2019?
How much income did your business make January 1, 2020 - January 31, 2020?
Do you have proof of expenses for your business? If so check the boxes below that apply *
Yes
No
Do you have proof of payroll reports that have been processed for 2019 thru March 31, 2020? *
Receipts
Invoices/Purchase Orders
1099-Miscellaneous
Bank/Credit Card Statements
Other statements
Do you have proof of mileage? *
Mileage Log
Journal
Other
Do you need assistance with gathering your docments for tax purposes *
Yes
No
Do you need assistance with recording your company's financial data? *
Yes
No
SALES TAX
If you are required to pay sales tax (sell goods) please fill out this section
How do you process Sales Tax? *
Self prepare
Professional Tax Preparer/CPA/
Bookkeeping Service
I do not/have not processed sales tax for my business
N/A (service provider)
As of the date of this interview have you filed all sales tax for the past 36 months correctly and on time? *
Yes
No
Not sure
N/A
If you answered no list which agencies you owe. If you have received any notices for unresolved tax matters please upload them below.

Agencies include: IRS, State Department of Revenue...

Agency 1

Agency 2

Agency 3
File Upload - Upload copies of the notices your have received from agencies here

Add File
BOOKKEEPING
This section will inquire about your companies bookkeeping practices.
If you intend to use Global Tax Service for bookkeeping services how often would you like to receive services. *
Monthly
Quarterly
Do you currently use a bookkeeping system? *
Yes
No
If you answered yes above please check all that apply *
Electronic bookkeeping system (Quickbooks, Wave, other)
Excel Spreadsheets
Handwritten Journals
Professional Bookkeeping Service
I don't keep track of anything
If you use a electronic of professional bookkeeping service list it here.

Name of bookkeeping service name
Payroll Management
How do you currently process payroll?
Self prepare by hand
Self prepare using online software
Outsource to a payroll service (ADP, Paychex...)
I don't process payroll
How many employees do you have? *
1-10
11-25
26-50
50-100
100-500
N/A
Do you you have hourly employees? *
Yes
No
Do you you have salaried employees? *
Yes
No
Do you have a dedicated bank account for payroll? *
Yes
No
Banking Information
Do you have a business bank account? *
Yes
No
If you answered no would you like to set up a consultation to get a business banking account? *
Yes
No
Signature

By signing below, you acknowledge that you have read, understand, and accept your obligations and responsibilities and that you understand our responsibilities in services provided and explained above.
Clear
Privacy Policy. The nature of our work requires us to collect certain nonpublic personal information about you from various sources. We collect financial and personal information from applications, worksheets, reporting statements, and other forms, as well as interviews and conversations with our clients and affiliates. We may also review banking and credit card information about our clients in the performance of receipt of payment. Under our policy, all information we obtain about you will be provided by you or obtained with your permission. Our firm has procedures and policies in place to protect your confidential information. We restrict access to your confidential information to those within our firm who need to know in order to provide you with services. We will not disclose your personal information to any third party without your express permission, except where required by law. We maintain physical, electronic, and procedural safeguards in compliance with federal regulations that protect your personal information from unauthorized access. Please contact us with any questions regarding our privacy policy. I declare under penalty of perjury under the laws of the State Indiana that the foregoing is true and correct.

Initial Here

Owner/Partner 1
Owner/Partner 2
Owner/Partner 3
Owner/Partner 4

Agency 1
Agency 2
Agency 3

CONTACT INFO

Services

BUSINESS STRUCTURE INFO

Taxes

SALES TAX

BOOKKEEPING

Payroll Management

Banking Information