Please fill out this form in order to receive payments from the National Domestic Violence Hotline (The Hotline). The link provided to you via email is unique to this form and the data submitted is secured with end-to-end encryption. To protect your privacy, the information will be stored in a database that is safe with limited access by The Hotline employees.

The form has three sections: contact information; business type; provisions, terms, and conditions; payment authorization, and terms of service. After successful completion of the form, you will be notified by The Hotline that your application has been approved.

If you have any questions, please contact the Finance Department at finance@thehotline.org.

The National Domestic Violence Hotline
PO Box 90249
Austin, TX 78709
Administrative phone: 737-225-3150