Out-of-State Firm Permit and Authorization Application

Firm Information

You have selected to make application for a Firm Permit with Authorization to Perform Attest Compilation Services as an out-of-state firm.

The application fee for Firm Permit is $100.00.

	License Number:

The application fee for Authorization to Perform Attest and/or Compilation Services fee is based on number of licensee members and/or licensees employed by the firm. Please see the schedule below:

1-5 Licensees: $100.00
6-10 Licensees: $200.00
11 Licensees: $300.00

	License Status:

While you are in the application process please do not use the back button in your browser. If at any time you wish to exit the application process, please click the "Exit" button located at the bottom of the page.

	Expiration Date:

Firm Information

	I wish to renew my firm's authorization to perform attest/compilation services for the upcoming fiscal period (July 1 to June 30).	Yes	No

Please choose carefully. You will not be able to hit a "BACK BUTTON" once you choose. If you change your mind or inadvertently make the wrong choice, you will need to log out and come back to this page again.


Firm Name	Please verify the total number of Licensees associated with your firm.	Contact Person	FEIN
Address Line 1

	Address Line 2
Contact Information

Contact Information


City

Make all necessary corrections below.

	County	State	ZIP Code
Phone Number	Firm Name:		Fax Number	Contact Person:	Email	FEIN:
Address Line 1:		Address Line 2:
City:	County:	State:	ZIP Code:
Phone Number:

	Fax Number:	Email:


Has there been a change of firm name, address and/or contact information?	Yes	No


Firm Name or Address Change: (If you have more than 1 change please upload a document with all of the information required below)
State Registrations

State Registrations

	Type of Change:

List the states in which your firm holds a firm registration.

	Firm/Branch Name:		Contact Person:	FEIN:
Address Line 1:		State Registrations (Example: WV, OH, VA, FL)	Address Line 2:
City:

	County:	State:	ZIP Code:
Phone Number:	Fax Number:	Email:


For additional changes please upload a document with all of the above information.
Click here for recommendations on uploading files.


Have you formed a new firm or organized in any other form?	Yes	No


Firm Name:		Contact Person:	FEIN:
Address Line 1:		Address Line 2:
City:	County:	State:	ZIP Code:
Phone Number:	Fax Number:	Email:
To add any additional firm contact changes please upload a document indicating the changes.
Click here for recommendations on uploading files.

State Licenses

Listed below are the state licenses the board currently has on file.

State Licenses:

If you need to add additional states please add their abbreviations below. Example: WV, OH, VA, FL

Additional State Licenses:

Out-of-State Firm Permit and Authorization Application

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