Request Funds - Rotary Club of Ann ArborRotary Club of Ann Arbor

Payment Request Form

Rotary Club of Ann Arbor members must submit this form to request funds for project grants, club or foundation-related expenses, etc. Supporting documentation must be provided. A separate form should be submitted for each unique funding request. Please allow 1-2 weeks for all payment requests to be processed. Requests must be reviewed and approved by the Executive Committee before funds can be disbursed.

Date of Request*
MM slash DD slash YYYY
Name of Requestor*
First Last
Email*
Phone*
Committee
Description of Item*
Method of Payment*
- Check
- Wire Transfer
Amount*
Date Required*
MM slash DD slash YYYY
Payable to:*
Address of Recipient
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Funds to be drawn from:*
- Club
- Foundation
- I don't know
Budget Line Item
To which committee/budget line item should this expense be attributed? (Leave blank if you are uncertain)
Please upload supporting documentation
Drop files here or

Max. file size: 128 MB.
Any additional context that you'd like provide?

Payment Request Form

Thank you to our sponsors