FEF Payment Form

Payment Request Form
This form should be used for all FEF grant payments, including reimbursements, visitor payments, etc. (Example: visiting artists, outside speakers, etc.)

Please complete the form below, attach your receipt or invoice, and click submit. Once documentation is complete, FEF will send a check within a month. If you have any questions, email us at mholcomb@falmoutheducationfnd.org.

Please submit the form as soon as possible after you make your purchase(s) or receive an invoice. Please attach all receipts for your project or activities at the same time.

Today's Date

Date

Name

First NameLast Name

For what type of grant are you seeking payment?*

Teacher Opportunity Mini-GrantNew Project GrantContinuing Project Grant

Is this for a reimbursement or invoice payment?

ReimbursementInvoice

Your Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

E-mail

example@example.com

School

Title or subject of grant

Amount of grant

Amount of reimbursement or invoice

How are you sending your receipts/invoice to FEF? Make sure your receipt shows proof of payment.

I am mailing my receipts/invoice to FEF, Box 1061, Falmouth, MA 02541I am attaching my receipts/invoice to this formI am emailing my receipts/invoice to mholcomb@falmoutheducationfnd.org

Scan or take a photo of your receipt, save to your device or computer, and then attach as indicated. Make sure the receipt reflects the payment method, e.g., the name of the credit card used. If you used a credit card, delete all but the last four digits of your credit card number. If you cannot attach the copy, email it to mholcomb@falmoutheducationfnd.org or mail it FEF, Box 1061, Falmouth, MA 02541.

The check should be made out to:

In cases where the check should be made out to someone other than you, please provide the name of the person to whom the check should be made out and the address to which it should be mailed. If the payment is to come to you at your address, you do not need to complete the following.

Pay to the Order of:

First NameLast Name

Address to send payment

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry