2026 Updated Distribution Request Form

Agreement Number (consists of 1-2 letters and 8-9 numbers)

Name of Designated Advocate

First NameLast Name

Email Address

example@example.com

Beneficiary's Name

First NameLast Name

Has the beneficiary passed away?

We are sorry for your loss. Please contact our Trust Closure Department at 216-736-4540 to notify us of the passing and for next steps to process all final distribution requests.

You will have the opportunity to request and upload supporing documentation for up to 6 payees. If more than 6 payees are requested, please submit another online request.

Request Type (1)

Brief Description of Request (1)

If applicable, account number of bill to be paid (1)

Amount requested (1)

To whom should the check be written (payee)? (1)

Is the check being mailed to someone different than stated in the previous answer? (1)

if yes, To whose attention should the check be mailed? (1)

To What address should The Check be mailed? (1)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Payment frequency? (1)

Paid Monthly for How Many Months? (1)

Starting Month (1)

Ending Month (1)

Which Supporting Documents Are You Attaching? (1)

Supporting Document Attachment (1)

Do You Have Another Request to Add? (2)

Request Type (2)

Brief Description of Request (2)

If applicable, account number of bill to be paid (2)

Amount requested (2)

To whom should the check be written (payee)? (2)

Is the check being mailed to someone different than stated in the previous answer (2)

if yes, To whose attention should the check be mailed? (2)

To What address should the check be mailed? (2)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Payment frequency? (2)

Paid Monthly for How Many Months? (2)

Starting Month (2)

Ending Month (2)

Which Supporting Documents Are You Attaching? (2)

Supporting Document Attachment (2)

Do You Have Another Request to Add? (3)

Request Type (3)

Brief Description of Request (3)

If applicable, account number of bill to be paid (3)

Amount requested (3)

To whom should the check be written (payee)? (3)

Is the check being mailed to someone different than stated in the previous answer (3)

if yes, To whose attention should the check be mailed? (3)

to What address should the check be mailed? (3)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Payment frequency? (3)

Paid Monthly for How Many Months? (3)

Starting Month (3)

Ending Month (3)

Which Supporting Documents Are You Attaching? (3)

Supporting Document Attachment (3)

Do You Have Another Request to Add? (4)

Request Type (4)

Brief Description of Request (4)

If applicable, account number of bill to be paid (4)

Amount requested (4)

To whom should the check be written (payee)? (4)

Is the check being mailed to someone different than stated in the previous answer (4)

if yes, To whose attention should the check be mailed? (4)

To What address should the check be mailed? (4)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Payment frequency? (4)

Paid Monthly for How Many Months? (4)

Starting Month (4)

Ending Month (4)

Which Supporting Documents Are You Attaching? (4)

Supporting Document Attachment (4)

Do You Have Another Request to Add? (5)

Request Type (5)

Brief Description of Request (5)

If applicable, account number of bill to be paid (5)

Amount requested (5)

To whom should the check be written (payee)? (5)

Is the check being mailed to someone different than stated in the previous answer? (5)

if yes, To whose attention should the check be mailed? (5)

to What address should the check be mailed? (5)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Payment frequency? (5)

Paid Monthly for How Many Months? (5)

Starting Month (5)

Ending Month (5)

Which Supporting Documents Are You Attaching? (5)

Supporting Document Attachment (5)

Do You Have Another Request to Add? (6)

Request Type (6)

Brief Description of Request (6)

If applicable, account number of bill to be paid (6)

Amount requested (6)

To whom should the check be written (payee)? (6)

Is the check being mailed to someone different than stated in the previous answer? (6)

if yes, To whose attention should the check be mailed? (6)

to What address should the check be mailed? (6)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Payment frequency? (6)

Paid Monthly for How Many Months? (6)

Starting Month (6)

Ending Month (6)

Which Supporting Documents Are You Attaching? (6)

Supporting Document Attachment (6)

Total of All Requests

Please provide your current contact details below so we can stay in touch with you as the Designated Advocate.

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Is This a New Address?

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Designated Advocate Signature

After submitting your form, you will receive a simple confirmation email acknowledging receipt. Check your spam/junk mail folders for the confirmation if you do not receive it in your inbox. Do not submit the request again. For security reasons, this email will not include any submitted information or attachments. Please retain your original receipts and any supporting documents for your records.