Please use this form to submit check requests from the Partnership for the Arts & Humanities. Check requests must be submitted by 10AM the Tuesday prior to any events or activities where checks are to be delivered in person.

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Payable Line By

Requested By *

First

Last

Email *

Phone

Date Requested

Date Needed

Amount Requested *

Select Which Budget: *— Select Choice —Events & ProgrammingArtStart MACC GrantPartnership AdministrationBusiness District ManagementPartnership Print & MarketingFine Art GalleryArts Warehouse Maintenance & CustodialMembershipPartnership Grant Funds

Which Line Item:

(Examples: Art In Bloom, Fall Into Art, Christmas in the Village, Custodial Supplies, Art Gallery Supplies, etc.)

Approved By

First

Last

Make Payable To

Payable to Address

Address Line 1

Address Line 2

City

— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Payable Email

Delivery Method *

• Mail Check
• Hold Check in Office
• ACH Payment

W9 on File? *

• Yes
• No
• N/A

W9 Upload

Drag & Drop Files, Choose Files to Upload

If necessary, please upload the payee’s signed W9 form here.

Invoice Upload

Drag & Drop Files, Choose Files to Upload You can upload up to 10 files.

If necessary, please upload the payee’s invoice, contract, or official request for payment.

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