Project Intake Form for Research Tax Credits and other potential credit and incentives Please fill out the form below OWNER INFORMATION / REPORT PREPARED FOR:Entity Name:*Contact Name* First Last Type of BusinessStates Located InAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingType of EntitityC-CorpS-CorpSole ProprietorshipLLCWhat Type of Return for LLCForm 1040, Schedule C, E, or FForm 1120 or Form 1120SForm 1065Form 8832How Many Owners?Year End Calendar Year Fiscal Year Specific Date Date Format: MM slash DD slash YYYY Annual PayrollNumber of EmployeesDo You Use Outside Contracting for Design/Engineering? Yes No Do You Have Any Patents? Yes No Type of Potential R&D Product Process Software (IUS) W2 BOX 1 WAGESDOC COLLECTION / UPLOAD Drop files here or TAX RETURNS – Corporate and Personal NameThis field is for validation purposes and should be left unchanged.