Get Payment Request Form - Commonwealth Community Trust

The Payment Request Form from the Commonwealth Community Trust is essential for individuals seeking to request funds efficiently. This guide provides clear instructions to help you complete the form accurately and ensure timely processing.

Follow the steps to fill out the form correctly.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling out the beneficiary name field. Ensure that you enter the full name of the beneficiary as it appears in official documents.
3. Next, input the account number associated with the beneficiary. This helps identify the correct account for processing the payment request.
4. In the 'Make payable to' section, write the name of the payee who will receive the funds, along with their complete address including street address, city, state, and zip code.
5. Specify whether the check should be mailed to the payee listed above or a different individual by selecting the appropriate checkbox and providing that individual's information, if required.
6. If applicable, enter the account or invoice number related to the request in the designated field.
7. Clearly state the amount requested in dollars. Ensure accuracy to avoid delays.
8. Provide the date by which the payment is due to facilitate proper scheduling.
9. Indicate whether the beneficiary receives Supplemental Security Income (SSI) or Medicaid by checking the appropriate boxes.
10. SSI recipients should check the box confirming that the request does not include payment for food, shelter, or reimbursement.
11. The signor must certify the statements regarding authorization and the beneficiary's conditions by providing their printed name, signature, and date.
12. If a second signature is required, complete the additional signer's information likewise.
13. Lastly, include contact information such as telephone number and email address for any follow-ups.
14. Once all fields are properly filled out, save your changes. You may download, print, or share the completed form as needed.

Begin your request by filling out the Payment Request Form online today.