2024 AM Cup 300/Round Award Payment Form

National Amateur Cup Payment Form $300/Round Award - Region II

Please complete the following form for award payments
Contact Information
Club Requesting Payment*
Name of Person Requesting Payment*

First NameLast Name
Contact Email*
example@example.com
Contact Phone Number*
Please enter a valid phone number.
Match Details
Are you requesting award payments for multiple matches?

YesNo
Winning Club Name
Opponent Club Name
Enter information for each Match won
Match 1 Winning Club Name
Match 1 Opponent Club Name
Match 2 Winning Club Name
Match 2 Opponent Club Name
Match 3 Winning Club Name
Match 3 Opponent Club Name
Match 4 Winning Club Name
Match 4 Opponent Club Name
Match 5 Winning Club Name
Match 5 Opponent Club Name
Are you requesting award payments to a club or individual?

ClubIndividual
Payment Details
Payable to:*
Address for check to be mailed to:*

Street Address

Street Address Line 2

CityState

Zip Code
Please upload your W9*

jpg, jpeg, png, gif (1mb max.)
Cancelof
Download W9 Form from IRS Site

Complete form, sign, and upload to complete payment submission requst.
Signature

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Should be Empty:

National Amateur Cup Payment Form $300/Round Award - Region II