Please submit by July 1st
A $50 late fee will be charged after July 31, 2013.

Firm Permit

Firm permits are only needed by those firms with an office in this state practicing public accounting or using titles such as "CPA" or "LPA". Other firms may practice public accounting in this state and use "CPA" or "LPA" titles without a permit , if they perform such services through an individual who holds a valid CPA license from a substantially equivalent (SE) state (see nasbatools.com/display_page?id=105). (Or who personally holds SE status granted by the NQAS). The firm must also be authorized to provide these services in that person’s home state. Permits are issued and renewed on an annual basis. Multiple-office firms may register on one application, with one registration fee.

Firms providing audits, reviews, compilations or exams of financial information, tax, consulting and other services please complete this form and return.

Payment of $10 by credit card required.
Fields marked with an asterisk (*) are required.

1. Name of CPA or LPA practice unit:*:
2. Register below each ND office of the firm
	Office	Office Address	Person in Charge of Office
Correspondent Office*:
Additional Office 1:
Additional Office 2:
3. The firm provides the following services to the public: (please check all that apply)*	Audits Tax Reviews Consulting Compilations Exams of prospective financial information Other:
4. Please check the boxes below to verify the following*:	A simple majority of the ownership of the firm, in terms of financial interests and voting rights, belongs to licensees of a state or other recognized jurisdiction. All CPAs or LPAs associated with the firm whose principal place of business is in this state and who perform professional services in this state hold a valid certificate or license issued by this state. The firm and its owners are in compliance with all board rules regarding ownership.
5. Please list all states and jurisdictions in which the firm holds or has applied for a permit to practice public accounting or similar authorization (excluding North Dakota).
Credit Card Payment Information Section (Required)
First Name*:
Last Name*:
Address*:
City*:
State*:
Zip*:
Country*:
Phone:
Fax:
Email*:
The above information is correct and complete to the best of my knowledge and belief.

Signature Section (Required)
Signature:
Date: