OSWC Payment Request Form — Woodhull Freedom Foundation

OSWC Payment & Reimbursement Form

Is this for payment for services or reimbursement of expenses?

What is this payment or reimbursement for?

Approval of Expenses by..

Legal Name

Name by which you are known

Preferred method of payment. Please note – these are the only options available for reimbursement

Zelle -(NOTE: Your account must be connected to your bank. We cannot Zelle to a debit card!) please include email address or phone number associated with this account in the next field)

Paper Check (include the address where we should mail the check in the next field)

PayPal (please enter the email or unique link associated with your account.)

Zelle – email or phone number associated with account.

Paper Check

PayPal

Date of pay period

Is this a recurring payment?

If this is a recurring payment, how frequently is this payment to be made?

If this recurring payment has an end date, what is it?

What is the total amount for this payment?

Please upload any supporting documentation for the expenses here. If you have more than 10 items, email [email protected].

Maximum file size: 52.43MB

If you have not filled out a w9, please click the link below, fill one out, and attach it below once it is completed. https://www.irs.gov/pub/irs-pdf/fw9.pdf

Maximum file size: 52.43MB

Please Check

If you are human, leave this field blank.