Grants - Recipient Funding Instructions

Grant Award Agreement

Attachment D

Funding Instructions

"*" indicates required fields

Organization Name*

Email*

Please designate one email address that will be used for all communications regarding grant remittance:

Enter Email Confirm Email

For purposes of correspondence, Grantee prefers that mail be sent to:

Attention:*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

For purposes of remittance(s), Grantee prefers that checks be:*

Mailed to the correspondence address identified above

Mailed to a different address

Grantee prefers to receive wire transfer of funds

Remittance Address

Street Address Address Line 2 City State ZIP Code

Name of Bank

Wire Account Number

Bank Account Number

This field is hidden when viewing the form

Phone*

This field is hidden when viewing the form

Message

Comments

This field is for validation purposes and should be left unchanged.

Impact100 East Bay
P.O. BOX 2889 Castro Valley, CA 94546

Make an Impact

Connect