Jack's Family Fund - Our People, Our Priority Jack's Family Fund - Our People, Our Priority
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Disaster Relief Terms and Conditions

Please review and agree to our terms and conditions of disaster relief payments to individuals. You will also indicate your preference of payment method, direct deposit or check mailed via certified first-class mail.

Applicant Name(Required)
Please enter your name as you did on your Disaster Relief application.
Your application # can be found in the subject line of the confirmation email you received when you submitted your Disaster Relief Application.
Please use the same email address you used when submitting your application.
Terms and Conditions(Required)
Please read and indicate you accept each of the terms and conditions below.
Payment Method(Required)
Please indicate how you would like to receive your disaster relief grant payment.
Must be 9-digits
If available, please provide a voided check or a screen shot of your online account info to verify account ownership. This also helps make sure we have correct routing and account information.
Drop files here or
Max. file size: 32 MB, Max. files: 3.
    Verification of Account Information(Required)
    Jack's Family Fund will initiate direct deposit based on the routing and account number you have provided. We will not reissue payments sent to the incorrect account due to errors made by you on this form. Please make sure you have entered your account information correctly.
    Please enter exactly how the check should be made payable
    Address to mail check to(Required)
    Checks will be mailed via certified first class mail and require signature for delivery.
    Signature required for check delivery(Required)
    If someone is not available to sign for delivery, the postal carrier should leave a notice that it is being held at the post office for pick-up. It is your responsibility to pick-up the check in a timely manner. The post office will hold undelivered USPS certified mail for 15 days before returning it to the sender. Unclaimed checks will not be reissued.
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    124 West Oxmoor Road
    Birmingham, AL 35209
    United States

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