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Inland Regional Center

info@inlandrc.org

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

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Master Trust of California

Disbursement Request

Checks cannot be paid directly to a beneficiary.   If request is to pay cable, pest control, cell phone, or any other monthly service, bills must be sent directly to our offices.

If you need assistance with this form, please contact:

Trina Boyce – Senior Trust Associate at 909-382-4833 or tboyce@inlandrc.org

Vanesa Macias - Trust Associate at 909-382-4678 or vmacias@inlandrc.org

Requests are processed on Thursdays, 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:

Account Balance:

Approved by:

Referred to Committee?