Contact First Name

Contact Last Name

Location/Business Name

Phone

Enterprise Zone

(select one)

EZ Certification Number

Format (201X-C-XXXXXX) or (C/P-XXXXXX)

What fields are you planning on changing?

Select all of the tax credits you want to certify and have data to report

Reason for ammendment

Please note if you want to update your NAICS code, employee counts and wages, or items not directly related to the tax credits earned.