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Payment Requests

In order to submit a request for payment or reimbursement from CCRHF, please follow the steps below. If you have any questions, please send us an email

Request for Payment/Reimbursement


W-9: When receiving a payment from CCRHF for the first time, all vendors need to be entered into our payment system. Each new vendor must complete and sign a W-9 form. There are two options for sending a W-9:

  • Download, print and complete this form then mail to:

Contra Costa Regional Health Foundation

50 Douglas Drive, Ste 310

Martinez, CA 94553

  • Email us here to request a W-9 to be sent via DocuSign. This is fast and secure and only takes a few minutes to fill out.

CCRHF will prepare IRS Form 1099-NEC, for all individuals that have provided services of $600 or more during the calendar year.



To facilitate a payment or reimbursement, all requests must be initiated by filling out the payment request form. Be sure to fill out the information completely and provide details about the request including the date of service. Once this has been submitted, email the invoice and/or any other back up documentation to support the request to


Requests for payments must include an invoice. Vendors can this invoice or their own as long as it contains the same information (name, address, email, invoice date, invoice number, description of services, and amount). 


Requests for reimbursements must fill out the payment request form (choose reimbursement at the bottom of the form) and email all receipts or back up documents that equal the amount of the request to *Please submit all reimbursement requests within 45 days of the expenditure.


All invoices and/or reimbursements must be approved by the Program Manager prior to release of funds.


Once an invoice or reimbursement has been submitted, please email all back up documentation relating to that request on the same day. 


If a request for payment pertains to an expense or reimbursement from the month of December, all payment requests MUST BE SUBMITTED NO LATER THAN JANUARY 15.

Thank you!


If you have any questions regarding payment requests or reimbursements, please contact us.

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