Equitable Access to Credit Program Contribution Request

Please complete this request to contribute to the Equitable Access to Credit Program. Submit your completed request form before leaving the page as data will not be saved when you return. If you have any questions about this form, please contact the Program Manager by email at Shiloh.Penland@commerce.wa.gov or by phone at 360-890-2288.

Unified Business Identifier (UBI)

An individual that Commerce may contact about this contribution.

Phone

Contribution is non-refundable.

The $1 for $1 tax credit is capped at $1,000,000 annually per business entity.

Contribution Method*

B & O Tax Filing Frequency
Has this business made a contribution to the Equitable Access to Credit Program before?*

If this business has made a contribution before and has claimed all tax credit or this business has never made a contribution, please enter "0".

Information provided to the Department of Commerce may be subject to public disclosure, pursuant to Chapter 42.56 RCW.


By submitting, you agree and consent to provide personal data to the Department of Commerce (Commerce) in this request being processed, collected, used, disclosed and/or retained by Commerce and its employees or representatives for the purposes of administering the Equitable Access to Credit program, in accordance with Commerce policies and processes relating to personal data protection.


You acknowledge that the information provided in this request is accurate and agree that Commerce and its employees or representatives can contact you in relation to your contribution to the Equitable Access to Credit program.

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