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Business Name
*
Your First Name
*
Your Last Name
*
Contact Phone Number
*
Contact Email Address
*
Estimates are acceptable:
Do you, or any partial owner of this business, own any percentage of another business?
*
How many W-2s were issued in 2020?
*
How many W-2s were issued in 2021?
*
Did you operate under a full or partial shutdown order? *
Yes - Full
Yes - Partial
No
Did you receive a PPP Loan? *
Yes
No
Was the PPP loan forgiven? *
Yes
No
Type of Business or Industry
*
Additional Information That Might Be Useful
Local Referrer Name
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