Corporate Online Form – Brophy Community Foundation

Corporate Income Tax Credit Application

Corporation Name
Corporate Street Address
Street Address City State / Province / Region ZIP / Postal Code
Contact Name
Phone
Email
Corporate EIN
- Check box if donation is from an S corporation pursuant to ARS section 43-1089.04.
Name and EIN of parent S corporation if contributing company is a qualified subchapter S subsidiary
- Check box if corporation pays insurance premium tax.
NAIC Number (Insurance Companies Only)
Amount the corporation is requesting to donate
PLEASE VERIFY: