Growth Foundation Funds Payment Form

Growth Foundation Funds Payment Form
Select Payment Type*

Vendor PaymentReimbursement ** Reimbursement will not be processed without proof of payment**
Date*

MonthDayYear
Date
Payable To*
Name of Fund
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Invoice #
If Available
If Vendor Payment
Add Vendor W-9

Cancelof
Amount $*
Description of Expense*
Payment Method

Select One
Electronic Payment Transfers*

Direct Deposit (ACH) - No FeeSame Day Wire Transfer - $15 fee for wire transfer
Bank Name
Name on Account
City/State
Account Number
Route Number
Authorized Representative *
Printed Name
Signature*

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As the authorized representative of the above-referenced fund, I recommend payment/reimbursement as detailed. By signning this vendor payment recomendation, I represent that, to the best of my knowledge, the expenses and supporting documentation are true and accurate, and support the mission of the organization.
FOR INTERNAL USE ONLY
Approved By

ChairTreasure
Should be Empty:

Payment Method