SPH Foundation Payment Request

Please be sure to double-check your forms and documents for any typos or inconsistencies, especially in regards to banking information, and provide all necessary supporting documentation in order to prevent delays in processing. NOTE: This form will not accept any files not in .pdf format. For any questions, please email: fund@sph.cuny.edu

Payee Information

Payee Type

New or Existing?

Please choose your name/company:

Company Name

Payee First Name

Payee Last Name

EIN/SSN

Employee ID #

For students, enter your SSN

Payment Email

Payee Phone

Note: please always enter your current mailing address and let us know if it has changed. The Foundation requires your current address to send you year-end tax documents.

Payee Street Address

Payee City

Payee State

Payee Zip Code

Invoices

Invoice #

For students, enter your network ID or EMPLID. For consultants, this should correspond to your invoice #.

Due Date

Select the following Friday as your due date.

Services Description

Services

Description

Please click "Add another response" to add another line item.

Amount

Total Requested Amount

ACH Payment Form (Completed by Vendor)

Bank Name

Individual's Name on Bank Account

Routing Number

Account Number

Checking or Savings Account

CheckingSavings

Should the check be mailed to the address above?

YesNo, another address

Mailing Street

Mailing City

Mailing State

Mailing Zip/Postal Code

Funding Categories (Internal)

Uploads

W9 Form

Section II must be signed and dated. Handwritten and e-signatures are accepted. A typed name will not be accepted as a valid signature.

Invoice

Invoices must be itemized and include a breakdown of your hours, and must be in compliance with the terms of your Consulting Agreement with the Foundation.

Business Agreement

Please check that your Consulting Agreement has not expired.

Bank Statement/Voided Check/Letter from Bank Confirming Account

If requesting payment via ACH, ensure that your name, routing number, and account number correspond to your ACH information exactly. The document must be from the past six months. You will be paid into this account.

Bank Statement With Proof of Payment(s)

From your online bank account, please pull a statement showing proof of the exact charge to your account. This document should show your name and account/card number. It CANNOT be a phone screenshot. If you have multiple reimbursements, please upload proof for each.

Award Letter

Please attach the letter from the Foundation, or your supervisor or professor confirming your award and amount.

Original Receipt

Receipt should be itemized. Please include corresponding proof of your payment, such as a bank statement with your name listing the purchase or payment.

Schedule of Expenses

Associated Documentation 1

Please click the "Add another response" if you need to add more documentation.

Contact Information