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Corporate Tax Credit Request

1. STEP 1: RESERVE YOUR TAX CREDIT BY JUNE 30
  The CTO will submit an application to the state on your behalf. We will need your company’s name, EIN #, amount you wish to donate and contact information. Please fill out the form below to start the process.
  The corporate income tax credit has a fiscal year cap. The approval process is first come first serve and is a way for the DOR to ensure that the annual maximum is not over-subscribed.
2. STEP 2: REMITTING YOUR PAYMENT TO THE CTO:
  Once the AZ DOR approves your request. Payments must be submitted within 20 days to recive the tax credit.
  A company using the "general/standard" method of determining its estimated quarterly payments should net the remittance amount from its state tax liability, after the application of any other allowable credits.
Full Name*

First Name Last Name
E-mail*
Phone Number*

Area Code Phone Number
Corporation Name:

Corporate Street Address*

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

Corporate EIN:
S Corporation Part A:

Check box if this donation is from an S corporation pursuant to A.R.S. § 43-1089.04.
S Corporation Part B:

Name and EIN of parent S corporation if contributing company is a qualified subchapter S subsidiary:
Insurance Premium Tax

Our corporation will be claiming the credit against insurance premium tax liability.
NAIC Number
Identify and enter corporate tax year of the donation: Calendar Year:

Calendar Year: 20___ or Fiscal Year __/__/_____ and ending __/__/_____
Donation Request Amount:
Should be Empty:

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