Official Request for Payment
If you have not officiated for any of our school’s athletic games, please ask the school’s athletic director for a W-9. A check will not be written if we do not have a W-9 form. Note: All officials will be filling out a new W-9 form for the 2019-20 school year.
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
I Currently receive a retirement check from PERA
*
Yes
No
Date
*
-
Month
-
Day
Year
Date
SWINK VS
*
SPORT
*
Volleyball
Football
Wrestling
Girls Basketball
Boys Basketball
Baseball
Track
LEVEL
*
V Girls
JV Girls
C Girls
JH Girls
V Boys
JV Boys
C Boys
JH Boys
ROUND TRIP MILEAGE X $0.40
(The official that travels the furthest will be compensated if payment is requested.) No mileage is paid if officials live within 20 miles of Swink
OFFICIAL SIGNATURE
*
TOTAL $
*
office use only AD signature
Submit
Should be Empty: