Fillable KAITC Fee Payment Form (Kansas Department of Commerce)

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KAITC Fee Payment Form (Kansas Department of Commerce)

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KAITC Fee Form Ver#2017
Kansas Angel Investor Tax Credit (KAITC) Program
KAITC Fee Payment Form
(FOR PAPER CHECK PAYMENTS ONLY)
Please complete and enclose with your non-refundable fee payment
Applicant Name (Company, Investor, or Transferee): ______________________________________________
Address: _________________________________________________________________________________
Contact Name: ____________________________________________________________________________
Email: ___________________________________________________________________________________
Phone: ___________________________________________________________________________________
Amount of Payment (check one):
$500 Company Application Fee
$150 Investor Registration Fee
$150 Transferee Registration Fee
$50 Tax Credit Certificate Replacement Fee
Check Number: ____________________________________________________________________________
Check Payable to: Kansas Department of Commerce
Check Memo: KAITC Program Fees
Please mail all KAITC fee checks to:
Kansas Department of Commerce
Kansas Angel Investor Tax Credit Program
Attn: Wendi Lucero
1000 S.W. Jackson Street, Suite 100
Topeka, Kansas 66612-1354
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KAITC Fee Payment Form (Kansas Department of Commerce)

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Completed 20 July 2020

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