PPP LOAN FORGIVENESS QUESTIONNAIRE

CLIENT INFORMATION

Client Name*

Your Email*

(You will receive a copy of the completed form via email)

Address*

Street Address Address Line 2 City State ZIP Code

Primary Contact*

First Last

Primary Contact Email*

Primary Contact Phone*

Entity Type*

Entities with common or related owners*

LOAN INFORMATION

Bank Name*

Banker Name*

First Last

Banker Email*

Banker Phone*

PPP Loan Amount*

Date PPP Loan Funds Received*

PAYROLL INFORMATION

Payroll Processor*

Date of pay period beginning after loan funds were received*

Are You a Seasonal Business?*

Yes
No

Are You Electing 8 or 24 Week Period?*

8 Week
24 Week

Which Week Do You Intend to Apply for Forgiveness?*

How frequently are employees paid? Select all that apply. (Hold down the Ctrl Key to select multiple answers):*

OTHER

Did You Receive an EIDL Grant?*

Yes
No

Grant Amount

Grant Date

Who will be responsible for approving and submitting the loan foregiveness application?

E-Z CRITERIA

Are You Self-Employed and Do You Have No Employees?*

Yes
No

During the period you used PPP loan funds, did you reduce the total number of employees or the hours your employees worked?*

Yes
No

During the period you used PPP loan funds, did you reduce the wages or pay rate of any employee by more than 25%?*

Yes
No

Were you able to operate between February 15, 2020 and the end of the period the PPP Funds were used at the same level of business as before February 15, 2020 due to compliance with health directives related to COVID-19?*

Yes
No

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Phone

This field is for validation purposes and should be left unchanged.

PPP LOAN FORGIVENESS QUESTIONNAIRE