Fiscal Sponsorship Disbursement Form

Fiscal Sponsorship Payment Disbursement

Use this form as a fiscally sponsored artist to request funds from your account. Payment will be made within 5 business days of the request submission date.

Name on file to disburse funds to (individual)

First Last

This is the entity to which the check will be written and who will receive a 1099 at the end of the year. Please be sure that this individual has both a contract and a W9 on file with us. Otherwise, we will not be able to issue the check.

Name on file to disburse funds to (business/group)

This is the entity to which the check will be written and who will receive a 1099 at the end of the year. Please be sure that this entity has both a contract and a W9 on file with us. Otherwise, we will not be able to issue the check.

Address to send the disbursement to

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Contact Email

Additional contact email

If there is more than 1 contact in your fiscal sponsorship agreement, email of both parties in the contract must be entered here. Both will receive correspondence about this notice and future disbursements.

Date to be Disbursed

Please note that a check will be written to the name/W2 that is on file within 5 business days of the 1st business day of receiving this request.

Description of what the funds will be used for

Confirmation

I confirm that I am authorized to request the disbursement of funds from the fiscal sponsorship account. I also confirm that I will use the funds as described in the description of this form and for no other outside purpose.

Please note the requested funds should be used for activities as outlined within your original fiscal sponsorship agreement and need to fall within the mission of Studio at 550.