ACSA Region XV Rebate Form
Acknowledgement of Rebate Check Requirements:
Name of individual receiving check: ______Title of Individual receiving check: ______
FULL Address of individual to receive check: ______
Phone number of individual receiving check: ______
I acknowledge that the above budget analysis highlights where rebate funds will be expended.
On or before June 1, 2018 a list of all rebate funds issued for scholarships/grants; the name(s)/complete address(es) of the recipient(s) will be forwarded to the Region Controller. In addition a list with the amount of funds paid to individual(s) and/or company/organization and W-9 will be forwarded to the Region Controller.
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SignedDate
This form will be kept on file in the Controller’s Office for State ACSA audit purposes.
ACSA has asked we have information on Charter banking done under ACSA’s and it’s charter’s name.
Name of/on Account: ______Bank or CU ______
Was account opened with an individual’s Social Security number or IRS Tax Number? IRS Tax Number if used ______
In addition to this signed form the Region By-laws Standing Rule Requires: Standing Rule #1: RebatesThe Region Executive Board shall, at the first meeting of every year, determine the Charter rebate amount (indexed at $18 per State member per charter in 2000-01: $5 per RACSAM member). Charters will be required to submit their Action Plan, Committee Assignments, charter by-laws, multi-charter district representatives, up-dated membership roster and any other information determined by the Executive Board at the first Executive Board meeting of the year. Charters shall submit their Action Plan, Committee Assignments, charter by-laws, multi-charter district rep-representatives, updated membership roster and any other information determined by the Executive Board by the first Regional Assembly of the year and, in turn, shall receive their full rebate.
Charters that submit only part of the required information, but by the due date, shall receive 50% of the determined rebate and nothing more.
Charters that submit all of the required information, but between the first and second Regional Assemblies will receive 50% of the determined rebate and nothing more.
Charters that submit only part of the required information, but between the first and second Regional Assemblies will receive 25% of the determined rebate and nothing more.No rebates will be given for information received after the second Regional Assembly.