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Inland Regional Center

info@inlandrc.org

1365 S. Waterman Ave., San Bernardino, CA, 92408, US

Master Trust of California

Disbursement Request

If you need assistance filling out this form, contact Trina Boyce 909-382-4833 or Vanesa Macias at 909-382-4678.

Checks cannot be paid directly to a beneficiary, contact us for more information.

If request is to pay cable, cell phone, pest control, or any other monthly service, bills must be sent to Master Trust of California.

Requests are processed on Wednesday or in case of holiday, checks will be processed the next business day. Some requests require review by the Master Trust committee. If your request is referred to the committee for review, you will be notified.

Personal Information

Request Date

Date Picker

Indicate benefits Beneficiary receives (check all that apply)

Purchase Information

Purchase type

For future purchases, I understand that receipts must be submitted after purchase.

Should payment go out on an ongoing basis?

Do you have items to add to this request?

Do you have items to add to this request?

Total Requested

Make check payable to:

Mailing Address

Upload File(s)/Receipts

Click Here to Upload

For Master Trust Use Only:

Set Review Date For:

Trust #

Account Balance:

Approved by:

 

Referred to Commitee?