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Quarter 1 – Recipient Ledger Form – Due April 7

  1. Use the ledgers on the form below to record all payments made to your lender(s).
  2. Provide payment due amount, due date, actual payment amount, and payment date for each entry.
  3. Record the actual Amount Due as reported by your lender.
  4. Record the actual Amount you Paid.
  5. Maximum reimbursement is $400/month.
  6. Any payment made in excess of the Amount Due is not covered by NC LEAF.
  7. Notify NC LEAF if any contact information changes or if you have questions about the status of your reimbursements.

Hidden
Name(Required)
Your NC LEAF ID Number is your NC Bar License Number with your 4 number PIN at the end (e.g. 12345-1234). If you need your PIN resent, please email us.
Email Address(Required)

For each Proof of Payment Submission you will need the Lender name, Amount Due, Due Date, Payment Amount, Payment Date, and a scan or screenshot of proof of payment.
Record up to 10 payments below. If needed, you may return to the dashboard and make multiple submissions per quarter.

PAYMENT 1
Max. file size: 50 MB.

PAYMENT 2
Max. file size: 50 MB.

PAYMENT 3
Max. file size: 50 MB.

PAYMENT 4
Max. file size: 50 MB.

PAYMENT 5
Max. file size: 50 MB.

PAYMENT 6
Max. file size: 50 MB.

PAYMENT 7
Max. file size: 50 MB.

PAYMENT 8
Max. file size: 50 MB.

PAYMENT 9
Max. file size: 50 MB.

PAYMENT 10
Max. file size: 50 MB.

217 East Edenton Street
Raleigh NC 27601-10155

info@ncleaf.org

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