PCAN Deposit Verification

Deposit Verification Form

Pensacola Community Action Network, Inc.
Project Name*
Your Email (we will send a copy of this form to you at this email)*
example@example.com
Date of Deposit

MonthDayYear
Date
Donor Name #1*
Donation Amount #1*
Is this a Government Grant, Corporate Donation, or Individual Donation?*

IndividualCorporateGovernment501(c)(3) Non-ProfitOther
Is the 501(c)(3) a registered non-profit in Florida? Use this link to search: https://search.sunbiz.org/Inquiry/CorporationSearch/ByName

YesNoUnsure
Donor Name #2 (optional)
Donation Amount #2 (optional)
Is this a Government Grant, Corporate Donation, or Individual Donation?

IndividualCorporateGovernment501(c)(3) Non-ProfitOther
Is the 501(c)(3) a registered non-profit in Florida? Use this link to search: https://search.sunbiz.org/Inquiry/CorporationSearch/ByName

YesNoUnsure
Donor Name #3 (optional)
Donation Amount #3 (optional)
Is this a Government Grant, Corporate Donation, or Individual Donation?

IndividualCorporateGovernment501(c)(3) Non-ProfitOther
Is the 501(c)(3) a registered non-profit in Florida? Use this link to search: https://search.sunbiz.org/Inquiry/CorporationSearch/ByName

YesNoUnsure
Total Amount Deposited*
Purpose*
Signer Name (Must be an Authorized Signer for Project or PensacolaCAN Rep)*
Authorized Signature*

Clear
Please attach Bank Deposit Receipt/Copy of Checks/Lists of Donors and Addresses

Cancelof
If completed by PensacolaCAN Rep: Project Leader Email - Recommended)
example@example.com
For PCAN Authorized Representative Only

Date of Deposit:

Type of Deposit: Electronic____ Physical _____

Deposited into which account:

Entered in QuickBooks:
Should be Empty:

Deposit Verification Form