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Request Forms

Thank you for your inquiry about our service as Representative Payee.
Our guidelines are simple:


  • We expect a referral from an agency or family member who can help establish a budget.

  • The client must not have a history of violence.

  • The client must agree to a budget.

  • Our interaction with a payee client will be by mail or telephone.

  • We will pay bills directly to vendors/providers, with personal funds sent directly to the client.


To apply for Representative Payee services, please download, print, and sign the following forms:
Please include any information that you feel would be helpful 
and return the signed pages to:  Northwest Washington Payee Services - P.O. Box 4202 - Nooksack, WA 98276        Phone (360) 988-4517 * Fax (360) 353-4304

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