Fundraiser Disbursement | Jack's Family Fund

Fundraiser Disbursement Info

Is your organization the beneficiary of a recent fundraiser? Please provide the requested information so we (Jack’s Family Fund) can disburse the proceeds.

HTTPS protocol is used to encrypt all communication between your browser and the server. No data on this form will be shared externally or used for any purpose other than to disburse proceeds of a recent fundraiser.

Organization's Contact Information

Name(Required)

First Last

Organization(Required)

Email Address(Required)

Email Address Confirm Email Address

Phone(Required)

Preferred Method of Contact(Required)

Disbursement Information

Please provide copy of your organization's 501(c)3 designation OR most recent Form 990.(Required)

Drop files here or

Max. file size: 32 MB, Max. files: 4.

Payment method(Required)

The Jack’s Family Fund disburses funds via direct deposit whenever possible. If you prefer we process and mail a check or use some other payment method, please indicate that below.

Direct Deposit

Check

Other

Payment Method: Direct Deposit

Name of Account Holder(Required)

Bank Name(Required)

Routing Number(Required)

Account Number(Required)

Addenda (or Memo) to include with transaction

Verify Account Info:

If possible please provide a copy of voided check or document from your bank verifying account information.

Drop files here or

Max. file size: 32 MB, Max. files: 4.

Payment Method: Check

The Fund mails checks via certified first-class mail which requires signature for delivery.

Make Check Payable To:(Required)

Mail To:(Required)

Street Address Address Line 2 City State ZIP Code

Payment Method: Other

Payment Details(Required)

Please provide details about how best to issue your payment. For example, if we can do so using your organization’s online donation form or bill payment site, please provide the URL.

Form Submitted By(Required)