Grant Request For Funds Form Grant Request for Funds Form Use this form to request that Park Pride remit funds from your fiscal account. Please be sure to provide appropriate documentation. Date* Date Format: MM slash DD slash YYYY Name of person submitting this form* First Last Email of person submitting this form* Name of Park/Grant Number*Total amount of previously submitted matching fundsRequired if you received a Small Change, Community Building, or Legacy matching grant. If you are not sure of this amount, please refer to your last submitted request for funds form or email firstname.lastname@example.org.Amount of additional matching funds being submitted with this requestRequired if you received a Small Change, Community Building, or Legacy matching grant. Please enter the amount of matching funds being submitted for this request (above field).Total matching funds to-dateRequired if you received a Small Change, Community Building, or Legacy matching grant. This will field will auto-calculate the sum of what you entered for previously submitted matching funds and funds being submitted today.Documentation of matching funds for this request Drop files here or Required if you received a Small Change, Community Building, or Legacy matching grant. Please upload voided checks, paid invoices, or other documentation of matching funds being spent. You must have spent matching funds that equal or exceed your request from Park Pride. You do not have to upload documentation for matching funds submitted on previous requests.Total amount of previously submitted grant expenditures*If you are not sure of this amount, please refer to your last submitted request for funds form or email email@example.com.Amount of grant funds being requested*Total grant expenditures requested to-date*This will field will auto-calculate the sum of what you entered for previously submitted grant expenditures and expenditures being submitted today.Expenses to be reimbursed/paid*DateVendorDescriptionAmount Receipts/invoices for current payment request*Please upload a receipt or invoice for each expense listed above.Payee Name*Park Pride can either reimburse a member of your Friends Group for expenses or pay a vendor directly.Payee Phone Number*Does this payment require Park Pride to have a W-9 for the payee on file?*YesNoIs the payee a contractor, freelancer, or consultant being paid more than $600? If so, Park Pride will need a W-9 from the payee.Upload Payee W-9*Does this payment require Park Pride to have a Certificate of Insurance (COI) for the payee on file?*YesNoIs 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*Preferred Method of Payment*Mailed checkACH direct depositA 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?*YesNoTo remit payment via ACH direct deposit, we must have an authorization form and voided check on file.ACH authorization form*The ACH authorization fillable PDF form is linked here.Voided check*Please upload a voided check for ACH payment.Address for check recipient* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Signature* CommentsThis field is for validation purposes and should be left unchanged.