Northwest RC&D Council – Request

Use this form to request payment, partial reimbursement for an approved project, or sponsorship from the Northwest RC&D Council.

This form may be used for:

Direct payment – if Northwest RC&D will pay the invoice directly.
Partial reimbursement – for expenses related to an approved project.
Sponsorship request – to request event or program support.

Please complete all sections of the form and upload required documentation, such as invoices, receipts, and supporting materials.

If you have any questions or need assistance completing this form, please contact:
Vanessa King
Operations Manager
vking@nwalrcd.org

Northwest RC&D – Request

Requesting Organization Name *

Type of payment requesting. * Select the type of request.Partial reimbursementSponsorship requestsDirect payment/Other

Provide a short description of request.

If you have a specific example or personal story from a beneficiary, please share.

Payee Name *

* Provide who the check should be made payable to.

Provide a mailing address for requested check.

City

City

State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

State/Province

Zip/Postal

Zip/Postal

Add Remove

Check Amount *

Attention *

* Please include a Department or Contact Name.

For reimbursement to Organization upload copies of Signed PO/Cancelled checks an/ bank statements and corresponding receipts.

Drop a file here or click to upload Choose File

Maximum file size: 52.43MB

Upload invoices to be paid directly.

Drop a file here or click to upload Choose File

Maximum file size: 52.43MB

Upload any additional documentation you would like to share.

Drop a file here or click to upload Choose File

Maximum file size: 52.43MB

List any questions you may have.

If you have a specific example or personal story from a beneficiary, please share.

Is this form complete and ready for review? *

Yes

No

Main Point of Contact *

Main Point of Contact

First Name

First Name

Last Name

Last Name

Email *

Phone *

If you are human, leave this field blank.