Fiscal Sponsorship Disbursement Request.

Fill out this form to request a disbursement of funds from your fiscally sponsored project account.

Disbursements are made weekly by ACH posting to your account on Friday.

Fund disbursement requests must be submitted via this online form by TUESDAY AT 10:00 AM PT to be included in that week’s ACH.

Any disbursement requests submitted AFTER the Tuesday deadline will be included in the FOLLOWING WEEK’S ACH.

Rush requests are no longer available.

All disbursement requests for funds must have a CURRENT balance report attached.

All project bank accounts must be authorized in order to receive funds. If you have not submitted your ACH AUTHORIZATION FORM, we cannot issue your disbursement.

Please contact fiscalsponsorship@filmindependent.org with any other requests or inquiries.
Disbursement Request
Project Title
Project Representative Full Name
Project Representative Email
Project Representative Phone
Project ID Number
Number beginning with 4010-05-XXX
US Tax ID #
Type of legal entity receiving the funds?

Other
How much would you like to withdraw?
NUMBERS and DECIMALS ONLY. You may only request your available balance. Do not write 'available balance'
What will you mostly be using these funds for?
If you selected "other" please describe what your funds will be used for.
Upload your current balance report: Please request a current balance report before requesting a disbursement.

NOTE: Balance reports dated more that four weeks from the time of this request are ineligible and will be rejected. All balance reports MUST be issued by Film Independent. Do not upload your personal records.
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Have you filled out an ACH Authorization form with your banking information prior to submitting this request?
Is this your first request?
If you would like the funds to be disbursed to a new US Tax ID # or have not turned in your W9, please upload your W9.

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How would you like your funds delivered?
Beneficiary Name as it appears on bank account
IMPORTANT: The beneficiary name and address on ACH Authorization Form MUST match the beneficiary name and address on your W9.
Beneficiary Full Address ( address, city, state, zip code)
Last Four Digits of Bank Account Number
This account must be the one that was submitted on your ACH form. You will not be able to change this account information unless there are extenuating circumstances, such as the close of a financial institution or a change of business entity. In the event you need to change banking information, or you haven't had your account authorized, you will need to request a new ACH Authorization Form be sent to you.
Bank Account ACH Routing Number
Is this a new account?
International Wire Transfer Information.

This section is for for overseas bank accounts ONLY. DO NOT fill out this information if you have a US bank account.
Bank Name
Bank Address
Name on Account
Account Number
For Domestic US Wires
Wire Routing Number
Swift Code
IBAN
Approver Email:
example@example.com
Select Fiscal Sponsor below for approval:
Funds received from this disbursement will only be used in accordance with the proposal and budget previously approved by Film Independent.
I understand that I am responsible for reporting any funds received through fiscal sponsorship to the IRS and that, if eligible, I will receive a 1099 from Film Independent at the end of the year.
By checking the box below, I certify that I am a paid member of Film Independent and that I am current on all reporting due to Film Independent at this time. I understand that I am both legally and contractually responsible for reporting annually on any funds received through my fiscal sponsorship with Film Independent and will file all required project reports and detailed financial accounting, including providing receipts upon request, for funds received from this disbursement
Additional Requests / Comments?
Should be Empty:

Disbursement Request

International Wire Transfer Information.