Fiscal Sponsor Payment Authorization Form

"*" indicates required fields

Company

This field is for validation purposes and should be left unchanged.

Date*

Name of Authorized Project Liaison submitting this form*

First Last

Email of Authorized Project Liaison submitting this form*

Fiscal Sponsorship Account Name*

Payee Name*

Park Pride can either reimburse a member of your Friends Group for expenses or pay a vendor directly.

Payee Phone Number*

Is this a reimbursement?

Yes

A reimbursement does not require a W-9 or Certificate of Insurance (COI).

Does this payment require Park Pride to have a W-9 for the payee on file?*

Is the payee a contractor, freelancer, or consultant being paid more than $600? If so, Park Pride will need a W-9 from the payee.

Please do not submit sensitive financial information through this website form. This includes EINs, W9s, banking details, or any other sensitive vendor/tax information. We will reach out if we need additional information.

Does this payment require Park Pride to have a Certificate of Insurance (COI) for the payee on file?*

Is the payee is a third party vendor or contractor conducting work in the park? If so, the payee must provide a certificate of insurance to protect Park Pride from liability for injuries or damages.

Upload Payee Certificate of Insurance*

Max. file size: 50 MB.

Preferred Method of Payment*

A member of your Friends Group or a vendor can be paid either via a mailed check or ACH direct deposit.

Does Park Pride have the payee's ACH authorization on file?*

To remit payment via ACH direct deposit, we must have an authorization form and voided check on file.

Address for check recipient*

Street Address Address Line 2 City State ZIP Code

Expenses to be reimbursed/paid*

Date

Vendor

Description

Amount

Total Amount Requested*

If your amount requested is DIFFERENT than the invoice, please explain why.

Receipts/invoices*

Drop files here or

Max. file size: 50 MB.

Please upload a receipt or invoice for each expense listed above.

Any additional information you would like to share?

Signature of Authorized Project Liaison*

Fiscal Sponsor Authorization to Release Payment Form