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
Total Amount Deposited*
Purpose*
Date of Deposit

MonthDayYear
Date
Where was it deposited?

Through your donation platformDirectly to the bankOther
Donor Name #1*
Donation Amount #1*
Donation Amount #1*
Is this a Government Grant, Corporate Donation, or Individual Donation? #1*

IndividualCorporateGovernment501(c)(3) Non-ProfitOther
Is the 501(c)(3) a registered non-profit in Florida? #1 Use this link to search: https://search.sunbiz.org/Inquiry/CorporationSearch/ByName*

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

IndividualCorporateGovernment501(c)(3) Non-ProfitOther
Is the 501(c)(3) a registered non-profit in Florida? #2 Use this link to search: https://search.sunbiz.org/Inquiry/CorporationSearch/ByName*

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

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

YesNoUnsure
Total Amount Deposited
Signer Name (Must be an Authorized Signer for Project or PensacolaCAN Rep)*
Authorized Signature*
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:
Amount when Stripe Fees taken out:
Total Amount Deposited * 2.2% Fee + $.030 rate, IGNORE this field if the donor covered fees (ex. paid $53.53 instead of $50)
Should be Empty:

Deposit Verification Form