www.massrid.org

Payment Request Form

Coordinator: This form is proof you approve of the expense. Please fill it out. 

Your name:

Thank you for doing on-the-ground work for Mass RID!

Please take a moment to look this form over before your event or purchase.

You can use this form to request (please check one):

 Reimbursement for a purchase. Please include any receipts

 Payment for a vendor (speaker, interpreter, daycare, etc). Please include a contract and W-9

       Would they be willing to be contacted by MassRID for services again? yes no

 Payment for occupancy (rooms or space for an event, etc) Please include any receipts

I would like a check from Mass RID made out to:

Name:

Address:

Description of event (eg. workshop name and date):

Description of items, service, or location

(eg. “Interpreter services” or “food reimbursement”):

 Office Use:

Check#

Date

Amount:

$

Thanks again! The work you are doing is the reason MassRID exists! 

Now just mail this form to the email or street address shown below. All efforts will be made to get you your money promptly!

Massachusetts Registry of Interpreters for the Deaf

Treasurer ℅ Mary Fahey 31 Longmeadow Drive, Amherst, MA 01002

Treasurer@MassRID.org