Funds Transfer Details

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Contact ID

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Last Name

Transfer Amount

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Approved Amount Copy

Amount Requested (USD)

Enter the amount you are requesting in United States Dollars (USD).

Purpose

Approved Funding or Amount Requested (USD)

Receipts for Reimbursement*

If you have receipts to document this reimbursement, please upload them here.

Drop files here or

Accepted file types: jpg, jpeg, pdf, png, Max. file size: 20 MB.

Your Name

Your name should match exactly with the name on your government-issued identification.

First Name(s)*

First Surname or Last Name*

Second Surname

Contact Information

Email Address*

Phone Number*

WhatsApp Number

Western Union Details

City*

State*

Country*

Postal Code*

Wire Transfer Details

The information you provide below should match exactly with the information associated with your bank account.

Bank Routing Number, SWIFT Code, or BIC*

Account Number or IBAN*

Mailing Address*

City*

State or Region*

Country*

Postal Code*

Zelle Details

Zelle Phone Number*

Zelle Email*

PayPal Details

PayPal Email

Divvy Reimbursement Details

Receiving funds directly to your bank account via Divvy is an option for Affirmation Community Leaders within the United States to for reimbursements only. You will be invited to create an account if you do not yet have a Divvy account. Once created, you will use the Divvy app or website to request a reimbursement.

Once you have an account, you may request reimbursements directly through Divvy instead of using this form.

Your affirmation.org email will be used to invite you to create a Divvy account. If you do not yet have an affirmation.org email address, one will be created for you.

Divvy Credit Card Details

You will be invited to create an account if you do not yet have a Divvy account. Once created, you will use the Divvy app or website to retrieve the details of the virtual credit card assigned to you authorized with the approved amount.

The Divvy virtual credit card is a VISA card that can be used anywhere VISA is accepted.

If you are receiving funds to partially cover an expense, please be aware of any potential issues related to splitting the expense between two cards.

Receipts for purchases made using the Divvy card should be submitted via the Divvy app or website.

As Affirmation is a new Divvy customer, we have a limit of $2,000. Funding requests above this amount must be transferred using a different method. Funding requests with Divvy may be delayed due to the current account balance.

Confirm and Submit

When you receive funds from Affirmation: LGBTQ Mormons, Families & Friends, "Affirmation" or "Affirmation International," you are responsible for the appropriate use of the funds you receive and for adhering to Affirmation's Economic and Financial Policy.

To receive funds, you must agree to the following:

Only use funds for the purpose the funds are provided.
Provide a report of all related expenses and provide receipts for all related expenses within 15 days of your activity.

Please ensure that all information on this form is accurate. Inaccurate information may delay your receiving funds.