ERTC Advance ApplicationStep 1 of 6 - ERC FILING INFORMATION16%ERC Eligibility Reason Revenue Reduction Govt Shutdown Supply ChainIs this a PEO? Yes NoERC File DateERC File AmountERC Purchase AmountERC Preparer NameERC Preparer NumberERC Preparer Email Payroll Provider NamePayroll Provider NumberPayroll Provider Email CPA/Tax Preparer NameCPA Provider NumberCPA/Tax Preparer Email Business DBA Name:Business Name:*Business Phone:*Business Fax:Website:Industry Type:*Annual Gross Revenue*Merchant Type:*Please SelectRetailRestaurantServiceOtherBusiness Start DateFederal Tax ID:*State of Incorporation:*Please SelectAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificLegal Entity:*Please SelectCorpSole PropLLCPartnershipBusiness AddressBusiness Office Location:*Please SelectStoreOfficeHomeOtherHome AddressFull Legal Name First Last Home Phone:Cell Phone:*% of Ownership:*Title:*Date of BirthSSN:*Email:* VALID Government ID TypeState IDDriver's LicensePassportOtherID#Issued Date MM slash DD slash YYYY Expiration Date MM slash DD slash YYYY Any Additional Business Owners?NoYesAdditional Owner DetailsHome Address Owner 2:Full Legal Name Owner 2: First Last Home Phone Owner 2:Cell Phone Owner 2:% of Ownership Owner 2:Title Owner 2:Date of Birth Owner 2:SSN Owner2:Email Owner 2: VALID Government ID Type 2State IDDriver's LicensePassportOtherID 2#Issued Date 2 MM slash DD slash YYYY Expiration Date 3 MM slash DD slash YYYY Any Additional Business Owners #2?NoYesAdditional Owner #3 DetailsHome Address Owner 3:Full Legal Name Owner 3: First Last Home Phone Owner 3:Cell Phone Owner 3:% of Ownership Owner 3:Title Owner 3:Date of Birth Owner 3:SSN Owner3:Email Owner 3: VALID Government ID Type 3State IDDriver's LicensePassportOtherID 3#Issued Date 3 MM slash DD slash YYYY Expiration Date 3 MM slash DD slash YYYY Name of Authorized SignerTitleEmail Cell PhoneBank NameRouting NumberAccount NumberHiddenRouting NumberHiddenAccount NumberBank statements (3 Months/all pages) Drop files here or Select filesAccepted file types: pdf, xlsx, csv, xls, Max. file size: 500 MB.Documentation for ERC qualification (reason) from ERC filer Drop files here or Select filesAccepted file types: pdf, xlsx, csv, xls, Max. file size: 500 MB.ERC calculations to support the ERC filingBreakdown of wages by type and quarter. Confirm that PPP calculation is subtracted from ERC Drop files here or Select filesAccepted file types: pdf, xlsx, csv, xls, Max. file size: 500 MB.Please upload quarterly profit and loss statements for the years 2019 - 2021 Drop files here or Select filesAccepted file types: pdf, xlsx, csv, xls, Max. file size: 500 MB.Copy of the most recent year’s tax return Drop files here or Select filesAccepted file types: pdf, xlsx, csv, xls, Max. file size: 500 MB.2 most recent quarters of 941 Forms Drop files here or Select filesAccepted file types: pdf, xlsx, csv, xls, Max. file size: 500 MB.Copy of the front and back of all individual’s government issued photo ID who owns 20% or more of the entity (or authorized signatory) Drop files here or Select filesAccepted file types: pdf, xlsx, csv, xls, Max. file size: 500 MB.IRS Form 941 (original return) and 941X (amended return) filed to the IRS for each quarter the business is requesting the ERC Drop files here or Select filesAccepted file types: pdf, xlsx, csv, xls, Max. file size: 500 MB.Certification and Authorization:The business identified above and its owner(s) or principal(s) (collectively “Seller”) represents, acknowledges and agrees: (1) all information and documents provided to Finance ERC LLC (“Purchaser”) are true, accurate and complete and (2) if Seller learns prior to the purchase or at any other time that any information provided is not true, accurate and complete, Seller will notify Purchaser immediately. Seller authorizes Purchaser to investigate and verify any references given or any other statements, information or data provided or obtained regarding Seller. Seller further represents that he or she is authorized to offer Seller’s Employee Retention Tax Credits (“ERC”). Credit File Authorization:The Seller gives Purchaser “written instructions” to obtain information from Seller’s personal credit file or other information from consumer reporting agencies solely for qualifying the Seller; (2) authorizes Purchaser and each of Purchaser’s representatives, successors and designees (collectively, “Recipients”) to request and receive any investigative reports, credit reports, statements from creditors or financial institutions, verification of information, or any other information that a Recipient deems necessary; and (3) waives and releases any claims against Recipients and any information-providers arising from any act or omission relating to the requesting, receiving or release of information. Consent to Speak with and Communicate with Third Parties on Behalf of Seller:The Seller authorizes Purchaser to speak with third parties during the application/underwriting process and post closing of the transaction. Such third parties may include, but not limited to ERC consulting/filing providers, accountants, CPAs, attorneys and/or other third party advisors/consultants familiar with Seller to discuss further information about the Seller. Banking Information Authorization:The Seller agrees to share its banking information with Purchaser and authorizes the use of Decision Logic (and/or equivalent) to retrieve this information. Seller acknowledges and agrees that when Decision Logic (and/or equivalent) or its service providers access and retrieve information from third party sites, Decision Logic and its service providers are acting as your agent. Consent to Electronic Communications:The Seller authorizes Purchaser to contact Seller at any telephone number (including mobile, business, home and/or personal telephone numbers) or email address provided to Purchaser from time to time for any lawful reason and no such contact shall be deemed unsolicited. Seller authorizes Purchaser to contact Seller using any means of communication, including phone call, facsimile, mail, overnight delivery, email or text message, and including communications made using automated systems, artificial voices or pre-recorded messages, even if such method of communication results in charges to Seller. Consent*By signing below, each of the above listed business and business owner/officer (individually and collectively, “you”) certify that you are authorized to apply on behalf of the above listed business and all information provided is true and accurate. You agree to immediately notify VS Global Funding, LLC (“VSGF”) of any material change in financial condition. You authorize VSGF and each of its representatives, successors, assigns and designees (“Recipients”) that may be involved with or acquire commercial loans having daily repayment features or purchases of future receivables including Merchant Cash Advance transactions, including without limitation the application therefore (collectively, “Transactions”) to obtain consumer or personal, business and investigative reports and other information about you, including credit card processor statements and bank statements, from one or more consumer reporting agencies, such as TransUnion, Experian and Equifax, and from other credit bureaus, banks, creditors and other third parties. You also authorize VSGF to transmit this application form, along with any of the foregoing information obtained in connection with this application, to any or all of the Recipients for the foregoing purposes. You also consent to the release, by any creditor or financial institution, of any information relating to any of you, to VSGF and to each of the Recipients, on its own behalf. Furthermore, you hereby waive and release any claims against VSGF, all Recipients, and any information.providers arising from any act or omission relating to the requesting, receiving or release of the information obtained in connection with this application. Consent approvalDate Owner 1Signature Owner 1:*Reset signature Signature locked. Reset to sign again Date Owner 2Signature Owner 2:Reset signature Signature locked. Reset to sign again Date Owner 3.Signature Owner 3:Reset signature Signature locked. Reset to sign again CommentsThis field is for validation purposes and should be left unchanged. VS Global Funding NMLS 2085031Address354 NW 132 PLMiami, FL 33182Emailval@vsglobalfunding.com Call us+1786-565-8251Let’s talk First Name Last Name Email Address Message Submit