Fiscal Sponsorship Donation Form 2016-2017

 Fiscal Sponsorship Donation Form 2016-2017
TODAY’S DATE ______________________________________________
MEMBER NAME _____________________________________________
NAME OF CONTACT IF DIFFERENT __________________________________________________________
ORGANIZATION (IF APPLICABLE) ____________________________________________________________
PHONE NUMBER ____________________________________________
SOCIAL SECURITY OR FED ID# _________________________________________________
(This must be consistent all year long.)
MAKE CHECKS PAYABLE TO ____________________________________________________
(This must be consistent all year long. 1099 will be addressed to this name.)
PLEASE MAIL CHECKS TO _____________________________________________________________________________________________________________________________
NAME, STREET, CITY, STATE, ZIP
Check this box if your address has changed
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Please fill out the three columns below. Failure to do so will delay processing.
Checks must be made payable to NEW YORK LIVE ARTS, Inc. and earmarked to the member’s name.
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Make a copy of this form and all checks for your records. Submit the originals to: New York Live Arts, 219 W. 19
Street. New York, NY 10011, Attn: Fiscal Sponsorship
All checks are deposited weekly on Tuesdays. Checks must be received by Monday at 6pm to be deposited that
Tuesday. Checks will be mailed on Friday, 18 days from the deposit date.
DONOR NAME AND ADDRESS
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5.
CHECK #
CHECK AMOUNT