Penn Legacy - Check Request Form
Please submit payment request below.
Checks are cut weekly on Thursdays.
Please allow time for request approval, processing, and for mailing time.
Questions? email firstname.lastname@example.org
Enter Today's Date as 00/00/0000
Enter name of person completing this request form.
enter as format 111-111-1111
Evaluator - Tryouts
Summer School of Xcellence
Winter School of Xcellence
Other (please note details in comments field)
If payment is for tournament or other related to a team please complete this field.
If payment is for tournament or other related to a team please complete this field - note boys teams are listed after girls teams, please scroll to select the correct team.
PLTeamID-1: Penn Legacy 09 Black F09
PLTeamID-2: Penn Legacy 09 White F09
PLTeamID-3: Penn Legacy 08 Black F10
PLTeamID-4: Penn Legacy 07 Black F11
PLTeamID-5: Penn Legacy 07 White F11
PLTeamID-6: Penn Legacy 06 Black F12
PLTeamID-7: Penn Legacy 05 Black F13
PLTeamID-8: Penn Legacy 05 White F13
PLTeamID-9: Penn Legacy 04 Black F14
PLTeamID-10: Penn Legacy 04 White F14
PLTeamID-11: Penn Legacy 03 Black F15
PLTeamID-12: Penn Legacy 02 Black F16
PLTeamID-13: Penn Legacy 02 White F16
PLTeamID-14: Penn Legacy 01 Black F17
PLTeamID-15: Penn Legacy 01 White F17
PLTeamID-16: Penn Legacy 00 Black F18
PLTeamID-17: Penn Legacy 99 Black F19
PLTeamID-18: Penn Legacy 09 Black M09
PLTeamID-19: Penn Legacy 09 White M09
PLTeamID-20: Penn Legacy 08 Black M10
PLTeamID-21: Penn Legacy 08 White M10
PLTeamID-22: Penn Legacy 07 Black M11
PLTeamID-23: Penn Legacy 07 White M11
PLTeamID-24: Penn Legacy 06 Black M12
PLTeamID-25: Penn Legacy 06 White M12
PLTeamID-26: Penn Legacy 05 Black M13
PLTeamID-27: Penn Legacy 04 Black M14
PLTeamID-28: Penn Legacy 03 Black M15
PLTeamID-29: Penn Legacy 03 White M15
PLTeamID-30: Penn Legacy 02 Black M16
PLTeamID-31: Penn Legacy 02 White M16
PLTeamID-32: Penn Legacy 01 Black M17
PLTeamID-33: Penn Legacy 99 Black M19
Date Check Payment Due (Tournaments Only)
Do you have a file or document to upload for this request?
Be sure to include confirmation of application if for a tournament fee payment request.
Do you have an invoice or document to attach. If so upload it please.
Pay to Name
Enter as it should appear on check payment
Full Mailing Address
Enter address to which payment should be mailed
ONLY if not on attached invoice
Enter total number of hours worked if applicable
Dates of Service
Be sure to include a tournament application number if the request is for a tournament fee payment.
Send me a copy of my responses
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