{"id":739,"date":"2015-11-02T01:25:08","date_gmt":"2015-11-02T01:25:08","guid":{"rendered":"http:\/\/pajewishendowment.org\/?page_id=739"},"modified":"2019-08-09T17:24:35","modified_gmt":"2019-08-09T17:24:35","slug":"daf-form-disbursements","status":"publish","type":"page","link":"https:\/\/pajewishendowment.org\/en\/daf-form-disbursements\/","title":{"rendered":"DAF Form Disbursements"},"content":{"rendered":"<p><img loading=\"lazy\" class=\"aligncenter wp-image-995 size-full\" src=\"https:\/\/pajewishendowment.org\/wp-content\/uploads\/2015\/11\/logo-heart.png\" alt=\"logo-heart\" width=\"312\" height=\"104\" srcset=\"https:\/\/pajewishendowment.org\/wp-content\/uploads\/2015\/11\/logo-heart.png 312w, https:\/\/pajewishendowment.org\/wp-content\/uploads\/2015\/11\/logo-heart-300x100.png 300w\" sizes=\"(max-width: 312px) 100vw, 312px\" \/><\/p>\n<div class=\"caldera-grid\" id=\"caldera_form_1\" data-cf-ver=\"1.9.7\" data-cf-form-id=\"CF5636aec28d477\"><div id=\"caldera_notices_1\" data-spinner=\"https:\/\/pajewishendowment.org\/wp-admin\/images\/spinner.gif\"><\/div><form data-instance=\"1\" class=\"CF5636aec28d477 caldera_forms_form cfajax-trigger\" method=\"POST\" enctype=\"multipart\/form-data\" id=\"CF5636aec28d477_1\" data-form-id=\"CF5636aec28d477\" aria-label=\"DAF Form\" data-target=\"#caldera_notices_1\" data-template=\"#cfajax_CF5636aec28d477-tmpl\" data-cfajax=\"CF5636aec28d477\" data-load-element=\"_parent\" data-load-class=\"cf_processing\" data-post-disable=\"0\" data-action=\"cf_process_ajax_submit\" data-request=\"https:\/\/pajewishendowment.org\/en\/cf-api\/CF5636aec28d477\" data-hiderows=\"true\">\r\n<input type=\"hidden\" id=\"_cf_verify_CF5636aec28d477\" name=\"_cf_verify\" value=\"78a2afaf86\"  data-nonce-time=\"1777096247\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/en\/wp-json\/wp\/v2\/pages\/739\" \/><div id=\"cf2-CF5636aec28d477_1\"><\/div><input type=\"hidden\" name=\"_cf_frm_id\" value=\"CF5636aec28d477\">\r\n<input type=\"hidden\" name=\"_cf_frm_ct\" value=\"1\">\r\n<input type=\"hidden\" name=\"cfajax\" value=\"CF5636aec28d477\">\r\n<input type=\"hidden\" name=\"_cf_cr_pst\" value=\"739\">\r\n<div class=\"hide\" style=\"display:none; overflow:hidden;height:0;width:0;\">\r\n<label>Web Site<\/label><input type=\"text\" name=\"web_site\" value=\"\" autocomplete=\"off\">\r\n<\/div><div id=\"CF5636aec28d477_1-row-1\"  class=\"row  first_row\"><div  class=\"col-sm-12  single\"><div class=\"\"><p><center>Please be advised that the undersigned hereby recommends the following disbursement(s) from the:<\/center><\/p>\n<\/div><\/div><\/div><div id=\"CF5636aec28d477_1-row-2\"  class=\"row \"><div  class=\"col-sm-12  single\"><div data-field-wrapper=\"fld_7677564\" class=\"form-group\" id=\"fld_7677564_1-wrap\">\r\n\t<label id=\"fld_7677564Label\" for=\"fld_7677564_1\" class=\"control-label\">FUND NAME AND NUMBER<\/label>\r\n\t<div class=\"\">\r\n\t\t<input    type=\"text\" data-field=\"fld_7677564\" class=\" form-control\" id=\"fld_7677564_1\" name=\"fld_7677564\" value=\"\" data-type=\"text\"   aria-labelledby=\"fld_7677564Label\" >\t\t\t<\/div>\r\n<\/div>\r\n<\/div><\/div><div id=\"CF5636aec28d477_1-row-3\"  class=\"row \"><div  class=\"col-sm-12  single\"><div class=\"\"><p><center>-----------------------------------------------------------------------------------------------------<\/center><\/p>\n<\/div><\/div><\/div><div id=\"CF5636aec28d477_1-row-4\"  class=\"row \"><div  class=\"col-sm-6  first_col\"><div data-field-wrapper=\"fld_2824428\" class=\"form-group\" id=\"fld_2824428_1-wrap\">\r\n\t<label id=\"fld_2824428Label\" for=\"fld_2824428_1\" class=\"control-label\">ORGANIZATION NAME\/ADDRESS 1<\/label>\r\n\t<div class=\"\">\r\n\t\t<input    type=\"text\" data-field=\"fld_2824428\" class=\" form-control\" id=\"fld_2824428_1\" name=\"fld_2824428\" value=\"\" data-type=\"text\"   aria-labelledby=\"fld_2824428Label\" >\t\t\t<\/div>\r\n<\/div>\r\n<\/div><div  class=\"col-sm-6  last_col\"><div data-field-wrapper=\"fld_4872173\" class=\"form-group\" id=\"fld_4872173_1-wrap\">\r\n\t<label id=\"fld_4872173Label\" for=\"fld_4872173_1\" class=\"control-label\">$AMOUNT 1<\/label>\r\n\t<div class=\"\">\r\n\t\t<input    type=\"text\" data-field=\"fld_4872173\" class=\" form-control\" id=\"fld_4872173_1\" name=\"fld_4872173\" value=\"\" data-type=\"text\"   aria-labelledby=\"fld_4872173Label\" >\t\t\t<\/div>\r\n<\/div>\r\n<\/div><\/div><div id=\"CF5636aec28d477_1-row-5\"  class=\"row \"><div  class=\"col-sm-6  first_col\"><div data-field-wrapper=\"fld_466597\" class=\"form-group\" id=\"fld_466597_1-wrap\">\r\n\t<label id=\"fld_466597Label\" for=\"fld_466597_1\" class=\"control-label\">ORGANIZATION NAME\/ADDRESS 2<\/label>\r\n\t<div class=\"\">\r\n\t\t<input    type=\"text\" data-field=\"fld_466597\" class=\" form-control\" id=\"fld_466597_1\" name=\"fld_466597\" value=\"\" data-type=\"text\"   aria-labelledby=\"fld_466597Label\" >\t\t\t<\/div>\r\n<\/div>\r\n<\/div><div  class=\"col-sm-6  last_col\"><div data-field-wrapper=\"fld_1341106\" class=\"form-group\" id=\"fld_1341106_1-wrap\">\r\n\t<label id=\"fld_1341106Label\" for=\"fld_1341106_1\" class=\"control-label\">$AMOUNT 2<\/label>\r\n\t<div class=\"\">\r\n\t\t<input    type=\"text\" data-field=\"fld_1341106\" class=\" form-control\" id=\"fld_1341106_1\" name=\"fld_1341106\" value=\"\" data-type=\"text\"   aria-labelledby=\"fld_1341106Label\" >\t\t\t<\/div>\r\n<\/div>\r\n<\/div><\/div><div id=\"CF5636aec28d477_1-row-6\"  class=\"row \"><div  class=\"col-sm-6  first_col\"><div data-field-wrapper=\"fld_9594139\" class=\"form-group\" id=\"fld_9594139_1-wrap\">\r\n\t<label id=\"fld_9594139Label\" for=\"fld_9594139_1\" class=\"control-label\">ORGANIZATION NAME\/ADDRESS 3<\/label>\r\n\t<div class=\"\">\r\n\t\t<input    type=\"text\" data-field=\"fld_9594139\" class=\" form-control\" id=\"fld_9594139_1\" name=\"fld_9594139\" value=\"\" data-type=\"text\"   aria-labelledby=\"fld_9594139Label\" >\t\t\t<\/div>\r\n<\/div>\r\n<\/div><div  class=\"col-sm-6  last_col\"><div data-field-wrapper=\"fld_8373090\" class=\"form-group\" id=\"fld_8373090_1-wrap\">\r\n\t<label id=\"fld_8373090Label\" for=\"fld_8373090_1\" class=\"control-label\">$AMOUNT 3<\/label>\r\n\t<div class=\"\">\r\n\t\t<input    type=\"text\" data-field=\"fld_8373090\" class=\" form-control\" id=\"fld_8373090_1\" name=\"fld_8373090\" value=\"\" data-type=\"text\"   aria-labelledby=\"fld_8373090Label\" >\t\t\t<\/div>\r\n<\/div>\r\n<\/div><\/div><div id=\"CF5636aec28d477_1-row-7\"  class=\"row \"><div  class=\"col-sm-6  first_col\"><div data-field-wrapper=\"fld_1501893\" class=\"form-group\" id=\"fld_1501893_1-wrap\">\r\n\t<label id=\"fld_1501893Label\" for=\"fld_1501893_1\" class=\"control-label\">ORGANIZATION NAME\/ADDRESS 4<\/label>\r\n\t<div class=\"\">\r\n\t\t<input    type=\"text\" data-field=\"fld_1501893\" class=\" form-control\" id=\"fld_1501893_1\" name=\"fld_1501893\" value=\"\" data-type=\"text\"   aria-labelledby=\"fld_1501893Label\" >\t\t\t<\/div>\r\n<\/div>\r\n<\/div><div  class=\"col-sm-6  last_col\"><div data-field-wrapper=\"fld_8234417\" class=\"form-group\" id=\"fld_8234417_1-wrap\">\r\n\t<label id=\"fld_8234417Label\" for=\"fld_8234417_1\" class=\"control-label\">$AMOUNT 4<\/label>\r\n\t<div class=\"\">\r\n\t\t<input    type=\"text\" data-field=\"fld_8234417\" class=\" form-control\" id=\"fld_8234417_1\" name=\"fld_8234417\" value=\"\" data-type=\"text\"   aria-labelledby=\"fld_8234417Label\" >\t\t\t<\/div>\r\n<\/div>\r\n<\/div><\/div><div id=\"CF5636aec28d477_1-row-8\"  class=\"row \"><div  class=\"col-sm-12  single\"><div class=\"\"><p>I certify that no individual will receive goods, services or other items of value as a result of the Foundation making the recommended disbursement(s). I further certify that the recommended disbursement(s), if made, will not satisfy any legal obligations that I have incurred.<\/p>\n<\/div><\/div><\/div><div id=\"CF5636aec28d477_1-row-9\"  class=\"row \"><div  class=\"col-sm-12  single\"><div class=\"\"><p><center>-----------------------------------------------------------------------------------------------------<\/center><\/p>\n<\/div><\/div><\/div><div id=\"CF5636aec28d477_1-row-10\"  class=\"row \"><div  class=\"col-sm-6  first_col\"><div data-field-wrapper=\"fld_1303925\" class=\"form-group\" id=\"fld_1303925_1-wrap\">\r\n\t<label id=\"fld_1303925Label\" for=\"fld_1303925_1\" class=\"control-label\">SIGNATURE<\/label>\r\n\t<div class=\"\">\r\n\t\t<input    type=\"text\" data-field=\"fld_1303925\" class=\" form-control\" id=\"fld_1303925_1\" name=\"fld_1303925\" value=\"\" data-type=\"text\"   aria-labelledby=\"fld_1303925Label\" >\t\t\t<\/div>\r\n<\/div>\r\n<\/div><div  class=\"col-sm-6  last_col\"><div data-field-wrapper=\"fld_4621739\" class=\"form-group\" id=\"fld_4621739_1-wrap\">\r\n\t<label id=\"fld_4621739Label\" for=\"fld_4621739_1\" class=\"control-label\">PRINT YOUR NAME <span aria-hidden=\"true\" role=\"presentation\" class=\"field_required\" style=\"color:#ee0000;\">*<\/span><\/label>\r\n\t<div class=\"\">\r\n\t\t<input   required type=\"text\" data-field=\"fld_4621739\" class=\" form-control\" id=\"fld_4621739_1\" name=\"fld_4621739\" value=\"\" data-type=\"text\" aria-required=\"true\"   aria-labelledby=\"fld_4621739Label\" >\t\t\t<\/div>\r\n<\/div>\r\n<\/div><\/div><div id=\"CF5636aec28d477_1-row-11\"  class=\"row \"><div  class=\"col-sm-6  first_col\"><div data-field-wrapper=\"fld_6121693\" class=\"form-group\" id=\"fld_6121693_1-wrap\">\r\n\t<label id=\"fld_6121693Label\" for=\"fld_6121693_1\" class=\"control-label\">EMAIL ADDRESS <span aria-hidden=\"true\" role=\"presentation\" class=\"field_required\" style=\"color:#ee0000;\">*<\/span><\/label>\r\n\t<div class=\"\">\r\n\t\t<input   required type=\"email\" data-field=\"fld_6121693\" class=\" form-control\" id=\"fld_6121693_1\" name=\"fld_6121693\" value=\"\" data-type=\"email\" aria-required=\"true\"   aria-labelledby=\"fld_6121693Label\" >\t\t\t<\/div>\r\n<\/div>\r\n<\/div><div  class=\"col-sm-6  last_col\">\n<div data-field-wrapper=\"fld_3081084\" class=\"form-group\" id=\"fld_3081084_1-wrap\">\r\n\t<label id=\"fld_3081084Label\" for=\"fld_3081084_1\" class=\"control-label\">DATE<\/label>\r\n\t<div class=\"\">\r\n\t\t<input  type=\"text\" data-provide=\"cfdatepicker\" name=\"fld_3081084\" value=\"\" id=\"fld_3081084_1\" data-field=\"fld_3081084\" class=\"form-control cfdatepicker is-cfdatepicker\" data-date-format=\"yyyy-mm-dd\" data-date-start-view=\"month\"   aria-labelledby=\"fld_3081084Label\"   \/>\n\t\t\t<\/div>\r\n<\/div>\r\n<\/div><\/div><div id=\"CF5636aec28d477_1-row-12\"  class=\"row \"><div  class=\"col-sm-6  first_col\"><div data-field-wrapper=\"fld_1324976\" class=\"form-group\" id=\"fld_1324976_1-wrap\">\r\n\t<label id=\"fld_1324976Label\" for=\"fld_1324976_1\" class=\"control-label\">FOUNDATION AUTHORIZATION 1<\/label>\r\n\t<div class=\"\">\r\n\t\t<input    type=\"text\" data-field=\"fld_1324976\" class=\" form-control\" id=\"fld_1324976_1\" name=\"fld_1324976\" value=\"\" data-type=\"text\"   aria-labelledby=\"fld_1324976Label\" >\t\t\t<\/div>\r\n<\/div>\r\n<\/div><div  class=\"col-sm-6  last_col\"><div data-field-wrapper=\"fld_2466302\" class=\"form-group\" id=\"fld_2466302_1-wrap\">\r\n\t<label id=\"fld_2466302Label\" for=\"fld_2466302_1\" class=\"control-label\">PRINT NAME AUTHORIZATION 1<\/label>\r\n\t<div class=\"\">\r\n\t\t<input    type=\"text\" data-field=\"fld_2466302\" class=\" form-control\" id=\"fld_2466302_1\" name=\"fld_2466302\" value=\"\" data-type=\"text\"   aria-labelledby=\"fld_2466302Label\" >\t\t\t<\/div>\r\n<\/div>\r\n<\/div><\/div><div id=\"CF5636aec28d477_1-row-13\"  class=\"row \"><div  class=\"col-sm-6  first_col\"><div data-field-wrapper=\"fld_4296874\" class=\"form-group\" id=\"fld_4296874_1-wrap\">\r\n\t<label id=\"fld_4296874Label\" for=\"fld_4296874_1\" class=\"control-label\">FOUNDATION AUTHORIZATION 2<\/label>\r\n\t<div class=\"\">\r\n\t\t<input    type=\"text\" data-field=\"fld_4296874\" class=\" form-control\" id=\"fld_4296874_1\" name=\"fld_4296874\" value=\"\" data-type=\"text\"   aria-labelledby=\"fld_4296874Label\" >\t\t\t<\/div>\r\n<\/div>\r\n<\/div><div  class=\"col-sm-6  last_col\"><div data-field-wrapper=\"fld_5698938\" class=\"form-group\" id=\"fld_5698938_1-wrap\">\r\n\t<label id=\"fld_5698938Label\" for=\"fld_5698938_1\" class=\"control-label\">PRINT NAME AUTHORIZATION 2<\/label>\r\n\t<div class=\"\">\r\n\t\t<input    type=\"text\" data-field=\"fld_5698938\" class=\" form-control\" id=\"fld_5698938_1\" name=\"fld_5698938\" value=\"\" data-type=\"text\"   aria-labelledby=\"fld_5698938Label\" >\t\t\t<\/div>\r\n<\/div>\r\n<\/div><\/div><div id=\"CF5636aec28d477_1-row-14\"  class=\"row  last_row\"><div  class=\"col-sm-12  single\"><div data-field-wrapper=\"fld_4511009\" class=\"form-group\" id=\"fld_4511009_1-wrap\">\r\n<div class=\"\">\r\n\t<input  class=\"btn btn-default\" type=\"submit\" name=\"fld_4511009\" id=\"fld_4511009_1\" value=\"SUBMIT\" data-field=\"fld_4511009\"  >\n<\/div>\r\n<\/div>\r\n\t<input class=\"button_trigger_1\" type=\"hidden\" name=\"fld_4511009\" id=\"fld_4511009_1_btn\" value=\"\" data-field=\"fld_4511009\"  \/>\n<\/div><\/div><\/form>\r\n<\/div>\r\n\n<h4 style=\"text-align: center;\"><a href=\"https:\/\/pajewishendowment.org\/pdf\/2016-blank-form-heart.pdf\">Download Disbursement Form<\/a><\/h4>\n<p style=\"text-align: center;\">3211 North Front Street, Harrisburg, PA 17110<br \/>\nphone: 1-717-409-8220 fax: 717-236-0965<br \/>\ne-mail: <strong><a class=\"email\" href=\"mailto:info@pajewishendowment.org\">info@pajewishendowment.org<\/a><\/strong><\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Download Disbursement Form 3211 North Front Street, Harrisburg, PA 17110 phone: 1-717-409-8220 fax: 717-236-0965 e-mail: info@pajewishendowment.org &nbsp;<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":[],"_links":{"self":[{"href":"https:\/\/pajewishendowment.org\/en\/wp-json\/wp\/v2\/pages\/739"}],"collection":[{"href":"https:\/\/pajewishendowment.org\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/pajewishendowment.org\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/pajewishendowment.org\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/pajewishendowment.org\/en\/wp-json\/wp\/v2\/comments?post=739"}],"version-history":[{"count":13,"href":"https:\/\/pajewishendowment.org\/en\/wp-json\/wp\/v2\/pages\/739\/revisions"}],"predecessor-version":[{"id":2970,"href":"https:\/\/pajewishendowment.org\/en\/wp-json\/wp\/v2\/pages\/739\/revisions\/2970"}],"wp:attachment":[{"href":"https:\/\/pajewishendowment.org\/en\/wp-json\/wp\/v2\/media?parent=739"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}