Program Donation & Deposit Form
Please fill out this form completely when sending deposits of donations or payments to Athletes Charitable a division of United Charitable for your program. Be sure to include a telephone number where you can be reached if we have any questions. Do not endorse any checks to your program. Checks can be made payable directly to the name of your program or to Athletes Charitable a division of United Charitable with your program name on the memo line. Please make sure to distinguish between payments and donations. Type or print clearly.
Program Name:
*
Account #
Donation & Payment Type
*
General Donation / Gift
Program Service Revenue
Event Revenue
Government Grant
Grant Other
Event Name and Date
Donations / Payments
Deposits may contain both donations and payments in one check. When the donor receives something of value in return for their donation, the Fair Market Value (FMV) of the item is considered a payment and is not tax-deductible. The difference between the amount pay and the FMV of the item is the donation amount, which is tax-deductible. For deposits larger than five checks, please attach an additional spreadsheet.
Donations / Payments
*
Program Manager's Attestation
Neither you nor any of your family members – or any entity in which you (or your family) own 35% or more interest may donate to your program at Athletes Charitable a division of United Charitable. This is a strictly enforced IRS guideline. All donations and payments made to our programs are under the full legal authority of Athletes Charitable a division of United Charitable.
Date
*
-
Month
-
Day
Year
Date
Phone
*
Please enter a valid phone number.
Name
*
First Name
Last Name
Email
*
example@example.com
Signature
*
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Please mail all deposits to:
Athletes Charitable P.O.Box 715969 Philadelphia, PA 19171-5969
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