Funds Transfer Details "*" indicates required fields HiddenContact ID HiddenLast Name Transfer AmountHiddenApproved Amount CopyAmount Requested (USD)Enter the amount you are requesting in United States Dollars (USD). Approved Funding or Amount Requested Advance or Reimbursement? (Choose One)Please select the option most suitable for Affirmation to use to transfer funds to you. AdvanceFunds are sent prior to Affirmation related expenses are being made. Receipts must be submitted in accordance with Affirmation policies. Surplus funds must be returned according to Affirmation policies. ReimbursementFunds are sent after pre-approved Affirmation related expenses are made. Receipts must be submitted according to Affirmation policies. Transfer Options (Choose One)Please select the option most suitable for Affirmation to use to transfer funds to you. Western UnionOutside the United States only. Funds can be picked up from a Western Union retail location the same day the funds are sent. Wire TransferFunds are sent from Affirmation's bank account to your bank account. Within the United States, funds are usually available the next business day from when the funds are sent. Outside the United States, funds are usually available within 3-5 business days from when the funds are sent. PayPalFunds are sent from Affirmation's PayPal account to your PayPal account. Funds are usually available in your PayPal account immediately after they are sent. ZelleFunds are sent from Affirmation's bank account to your bank account via Zelle. Funds are usually available in your bank the same day the funds are sent. Divvy ReimbursementsFor reimbursements to Affirmation Community Leaders within the United States only. Funds are usually available 5-7 days after the they are sent. Divvy Virtual Credit CardFor advances. A virtual credit card will be issued to you for the approved amount. Receipts for Reimbursement*If you have receipts to document this reimbursement, please upload them here. Drop files here or Select files Accepted file types: jpg, jpeg, pdf, png, Max. file size: 20 MB. Your NameYour name should match exactly with the name on your government-issued identification.First Name(s)* First Surname or Last Name* Second Surname Contact InformationEmail Address* Phone Number*WhatsApp NumberWestern Union DetailsCity* State* Country*Select CountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsPostal Code* Wire Transfer DetailsThe 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 DetailsWhat should we use to send you funds via Zelle?* Email Phone Number Zelle Phone Number*Zelle Email* PayPal DetailsPayPal Email Divvy Reimbursement DetailsReceiving 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 DetailsYou 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 SubmitConfirmation and Agreement* I confirm that the information I have provided is correct. I understand inaccurate information may result in delays receiving funds. I understand that I am responsible for the appropriate use of these funds and for abiding all Affirmation policies regarding the use of these funds. Δ
