2024/25 General Payment Request

DO NOT

USE THIS FORM FOR TOURNAMENT SUBMISSIONS

For tournaments use: Tournament Payment Form

All Stateline Sports Group payment requests including, Stateline Fury, Lady Shamrocks, and Stateline Swanson Park must be submitted using this form. Stateline will process all requests received by the 15th of the month on the 30th, and all requests received by the 30th of the month on the 15th of the following month.

Submitted By*

First NameLast Name

Program:*

Team/Program Account:*

Expense Description:*

Assistant Coach

Association:

If Other please describe payment request

Amount:*

Pay To:*

First NameLast Name

Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

If payment is required before the current program policy, please explain in the comments section.

If payment is for an individual, we will need to have a W9 on file prior to payment being processed. If you need a W9, you can download it from our website at www.statelinesportsgroup.com under forms - Thank You!!

Comments

Upload receipt

Upload a File

MAX File Size of 11MB

Submission Date*

Todays Date

CHECK NUMBER

To be completed by administrative staff

MAILED DATE

To be completed by administrative staff

Team: