RERF Payment Request Form

To expedite your Restaurant Employee Relief Fund (RERF) payment, please complete this form.

Information provided in this form is encrypted with a 256 SSL connection, which complies with the Payment Card Industry Data Security Standard (PCI DSS). You may read more about the security of this form here. Additionally, information you provide is collected and stored in accordance with all applicable federal and state laws and regulations. Only select individuals at the NRAEF or its affiliates will ever have access to your information, and data will be deleted once RERF payments are complete.

Should you wish to provide your personal information in a different format, please contact rerf@nraef.org to discuss options.

Full Name*

First NameLast Name

Email - Must be the email used for RERF application*

example@example.com

How would you prefer to receive your RERF grant?*

Mail me a new checkDirect deposit into my personal bank account

Please note for mailed checks: We will send by either USPS or FedEx and will provide a tracking number when possible. The estimated time to receive a new check is 3-4 weeks. FedEx will not deliver to a P.O. Box.

Please note for direct deposits: Funds may only be deposited in your account. If there are any errors with the account information you provide leading to funding being deposited into an incorrect account, it cannot be reissued. The estimated time for a direct deposit is 1-2 weeks.

Mailing Address*

Street Address

Apartment/Unit Number

CityState

Zip Code

Please re-enter your mailing address to ensure accuracy*

Street Address

Apartment/Unit Number

CityState

Zip Code

Please enter the FIRST name on the account. *

Please re-enter the FIRST name on the account to ensure accuracy. *

Please enter the LAST name on the account.*

Please re-enter the LAST name on the account to ensure accuracy.*

ERROR: Names do not match.

Please note: The account provided must be in your name. If the name on the account is different than the name on your RERF application, please use the comment box below to explain the difference. For example: “My bank account is listed in my maiden name (Smith) and I applied for the RERF grant with my married name (Jones)." If you do not have any comments, please leave blank.

0/500

Please enter your account number:*

Please re-enter your account number:*

ERROR: Account numbers do not match.

Please enter your routing number:*

Please re-enter your routing number:*

ERROR: Routing numbers do not match.

For assistance retrieving and confirming correct routing and account numbers, please contact your bank.