Fiscal Sponsorship Disbursement Request

CCEA - Disbursement Request
Please fill out this form to request a disbursement from your fiscally sponsored project account. You must submit an ACH AUTHORIZATION FORM in order to receive your disbursement.

Disbursements are made weekly by ACH. Disbursement requests must be submitted by Monday at 5PM PST to be included in that week’s ACH transfer. Any disbursement requests submitted after the Monday deadline will be included in the following week's transfer. If Monday is a holiday, the deadline for disbursement requests will be the following business day.

Please contact info@ccearts.org with any questions.
Project Title*
Project Representative Name

First NameLast Name
Project Representative Email*
Project Representative Phone*
Type of legal entity receiving the funds?*

IndividualLLCS-CorpOther
Origin of funds requested
Donor & Amount (only needed if a donation was wired directly to CCEA)

Donor NameAmount
Total amount requested*
Numbers and decimals only - before CCEA fees
What will you mostly be using these funds for?*

Research/DevelopmentEditing ExpensesProduction ExpensesTravel ExpensesPost Production ExpensesSalariesMusicInsuranceTalentAdministrativeArchivalClearance/CopyrightOther
Is this your first request?*

NoYes - please attach your signed W9
If you would like the funds to be disbursed to a new US Tax ID # or have not turned in your W9, please upload your W9.

Cancelof
RUSH REQUESTS: all rush requests are subject to internal approval and must be submitted before 11am for same day transfers.

Rush Request - $100 fee
How would you like your funds delivered?*

ACH Direct Deposit (US Banks Accounts)Wire Transfer ($40 fee)
ACH Banking Information
All accounts must be authorized in order to receive funds via ACH. Please fill out this ACH AUTHORIZATION FORM if you haven't already or if you need to make any changes to your existing account.
Banking Information for wire transfers

(Please only fill this out if a wire transfer is desired instead of ACH)
Bank Name
Bank Address
Name on Account
Address associated with this account

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone number associated with this account
Please enter a valid phone number.
Account Number
For Domestic US Wires
Wire Routing Number
For Domestic US Wires
Swift Code
For International Wires
IBAN
For International Wires
Funds received from this disbursement will only be used in accordance with the proposal and budget previously approved by CCEA.*

I agree
I understand that I am responsible for reporting any funds received through fiscal sponsorship to the IRS.*

I agree
By checking the box below, I certify that I am current on all reporting due to CCEA. I understand that I am both legally and contractually responsible for reporting annually on any funds received through my fiscal sponsorship with CCEA and will file all required project reports and detailed financial accounting, including providing receipts upon request, for funds received from this disbursement*

I agree
Additional Requests / Comments?
Should be Empty:

CCEA - Disbursement Request

Origin of funds requested

ACH Banking Information

Banking Information for wire transfers