Vouchering

Now you can qualify your employees for Enterprise Zone Hiring Credits and recieve valuable credits to reduce your State Income Tax. Just complete this simple form and submit it. We will send you the voucher.

Enterprise Zone Pre-Application

(*) Required

Company Information
*Company Name:
*Contact Person:
*Phone: (xxx) xxx-xxxx
*Email:

Employment Information
*Wage Rate:
*Date Hired:
*Position:

Employee Information
*Full Name:
*SSN#:
*Street Address:
*City:
*State:
*Zip Code:
*Home Phone:
*Date of Birth: mm/dd/yy

Six months prior to hire, were you enrolled in any of the following programs?

Please Check all boxes that apply to you.















Six months prior to hiring, were you receiving any of the following?

Please check all boxes that apply to you.







*Please choose the number of family members living in your
household 6 months prior to hire:

*Please choose the amount closest to your total household income
6 months prior to hire:


Participation in this tax credit program is voluntary. If you have checked any of the boxes, you are potentially Enterprise Zone qualified. You must provide proof of eligibility before a tax credit can be issued. By sending this form you are acknowledging your participation in this program is voluntary and the answers you have given are true and correct to the best of your knowledge. Also, you give the Enterprise Zone representative your authorization to verify any information provided on this form within the next 6 months.