PAYMENT REQUEST form for UMBRELLA ACCOUNTS FRIENDS OF OAKLAND PARKS AND RECREATION 1520 LAKESIDE DRIVE, OAKLAND, CA 94612 (510) 465-1850 Person Submitting Request: _________________________________________ From: Organization or address: ______________________________________ To be drawn form Umbrella Fund named: ______________________________ Telephone Number to call with any questions: __________________________ Please make check payable to (vendor): _______________________________ For the amount of: _________________________________________________ (Attach original receipts, invoices or purchase orders) DELIVERY INSTRUCTIONS  Please mail check to: ____________________________________________ _________________________________________________________________ _________________________________________________________________  Please hold check in the Friends Office for pickup by: ___________________  Please call me at the following phone number when check is ready: _______ I certify that the above request is in accordance with the approved contract agreement with Friends of Oakland Parks and Recreation, and that all funds have and/or will be expended for educational and/or charitable purposes consistent with the mission of the nonprofit corporation. Authorized signer of grant: ______________________________________________ Print Name: __________________________________________________________ Telephone contact number: _____________________________________________ Date __________________ FOR OFFICE USE Check # ____________ Date: ____________________________