Freedom Project WA · Invoice/Reimbursement Request Form

Name

*

First Name

Last Name

Phone

*

Email

*

Verify Email

*

Invoice:

Check here if you are submitting an invoice (for contract work, emotional stipend, research stipend, etc)

Expense Reimbursement:

Check here if you are submitting for expense reimbursement (up to 5 reciepts)

Invoice for Services

What services are you invoicing for?

*

Administrative Support

Emotional Labor Stipend

Facilitation Stipend

Project Management

Technology Support

Research Stipend

Other

Service date or start date

*

(mm/dd/yyyy)

Service end date (if more than one day)

(mm/dd/yyyy)

Service Description

*

How is your pay being calculated?

*

Flat rate

*

Hourly Rate

*

Hours

*

Reimbursement

Date of Expense

*

(mm/dd/yyyy)

Expense total

*

Expense Description

*

Receipt for Reimbursement

*

Check here to include another expense and reciept for reimbursement.

Add another expense and reciept.

Date of Expense #2

*

(mm/dd/yyyy)

Expense Total #2

*

Expense Description #2

*

Receipt for Reimbursement #2

*

Check here to include another expense and reciept for reimbursement.

Add another expense and reciept.

Date of Expense #3

*

(mm/dd/yyyy)

Expense Total #3

*

Expense Description #3

*

Receipt for Reimbursement #3

*

Check here to include another expense and reciept for reimbursement.

Add another expense and reciept.

Date of Expense #4

*

(mm/dd/yyyy)

Expense Total #4

*

Expense Description #4

*

Receipt for Reimbursement #4

*

Check here to include another expense and reciept for reimbursement.

Add another expense and reciept.

Date of Expense #5

*

(mm/dd/yyyy)

Expense Total #5

*

Expense Description #5

*

Receipt for Reimbursement #5

How would you like to be paid?

*

Username or email address associated with payment service selected above

*

Address for Mailed Check

*

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Have you ever received a direct deposit from Freedom Project before or submitted a direct deposit form?

*

Have you submitted a W-9 to Freedom Project before?

*

IMPORTANT: To submit a direct deposit form, follow this link and fill out the first page ONLY.

https://app.hellosign.com/s/CoWx97SD

The direct deposit form is not required before submitting this form, however we cannot pay you until we also receive your direct deposit information. You will also recieve the link to the direct deposit form via email confirmation once you submit this form. Contact Kiki or Chanel with any questions you have about filling out this form. If this request is related to the research project, you can also contact Linsay or Yolanda for support.

IMPORTANT: To submit a direct deposit form, follow this link and fill out the first page ONLY.

https://app.hellosign.com/s/CoWx97SD

The direct deposit form is not required before submitting this form, however we cannot pay you until we also receive your direct deposit information. You will also recieve the link to the direct deposit form via email confirmation once you submit this form. Contact Kiki or Chanel with any questions you have about filling out this form. If this request is related to the research project, you can also contact Linsay or Yolanda for support.

IMPORTANT: To submit a W-9 form, follow this link and fill out the second page ONLY (pages 3 and beyond are instructions).

https://app.hellosign.com/s/CoWx97SD

The W-9 form is not required before submitting this form, however we cannot pay you until we also receive your W-9. You will also recieve this link to the W-9 form via email confirmation once you submit this form. Contact Kiki or Chanel with any questions you have about filling out this form. If this request is related to the research project, you can also contact Linsay or Yolanda for support.

IMPORTANT: To submit a direct deposit and W-9 form, follow this link and fill out both the first and second pages (the rest are instructions for the W-9 form).

https://app.hellosign.com/s/CoWx97SD

The direct deposit and W-9 forms are not required before submitting this form, however we cannot pay you without this additional information. You will also recieve the link to these two forms via email confirmation once you submit this form. Contact Kiki or Chanel with any questions you have about filling out this form. If this request is related to the research project, you can also contact Linsay or Yolanda for support.