Trash for Cash_ Payment Request Form

Trash for Cash_ Payment Request Form
Great Job - Your organization has completed your Trash for Cash Cleanup(s)!

It is now time for the final Step: Requesting Payment

REMINDER: Payment requests typically take atleast two weeks to complete.

The Brightside Trash for Cash Program is made possible by the Kentucky Pride Fund and in partnership with the Louisville Metro Government Clean Collaborative.

Call Brightside at 502.574.2613 with questions.
This form is for approved Trash for Cash participants only.
Name of Non Profit Organization: (As it should appear on the check.)
Mark each checkbox to confirm that each required program task has been completed before requesting payment.
Cleanup Leader Name

First NameLast Name
Cleanup Leader Email Address
example@example.com
Please select how you would prefer to receive your Trash for Cash payment check:
Trash for Cash Payment checks must be mailed to a specific person, not a general address. Please provide the name that should be written on the envelope.
Please provide a direct mailing address to send the payment check to.

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Who will be picking up the check on behalf of the Organization?
First Name, Last Name
How would you prefer to be notified when the check is ready for pickup?
Phone or Email
Brightside staff will let you know when your check is ready!

REMINDER: Payment requests typically take atleast two weeks to complete.

The Brightside Trash for Cash Program is made possible by the Kentucky Pride Fund and in partnership with the Louisville Metro Government Clean Collaborative.

Call Brightside at 502.574.2613 with questions.
Brightside offers language access assistance free of charge.
Should be Empty:

Trash for Cash_ Payment Request Form

This form is for approved Trash for Cash participants only.

Brightside staff will let you know when your check is ready!