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Payment Request Form Instructions <br />• Type or print legibly all entries <br />• Round all amounts to the nearest whole dollar <br />The following instructions correspond to items on the Payment Request Form: <br />1. PROJECT Number - The number assigned by OGALS to this project <br />2. CONTRACT Number - As shown in Certification of Funding section of the CONTRACT <br />3. GRANTEE - GRANTEE name as shown On the CONTRACT <br />4. PROJECT Title - Name of the PROJECT as shown in the Application <br />5. Type of Payment — check appropriate box on form: <br />6. Payment Information <br />a. GRANT amount <br />b. Funds received to date - amount paid out from this GRANT <br />c. Available - (a. minus b.) <br />d. Amount of this request <br />e. Remaining funds after this payment - (c. minus d.) <br />7. Send Warrant To - GRANTEE name, address and contact person <br />8. Signature Of AUTHORIZED REPRESENTATIVE according to the Resolution <br />I <br />