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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.



Online Payment Request Form: Please fill out this online payment request form for each payment or reimbursement request. 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


Invoice: All requests for payments much 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).


Reimbursement Requests: All requests for reimbursement must include receipts that equal the amount of the request.


All back up documentation must be emailed to on the same day that the online payment request form is submitted.


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

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