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Payment Form Fillable PDF

The payment option that you select will be apply to your monthly cash grant as well as all other QIN payments, not to include QIN Payroll.

Check

  • If you do not already have direct deposit or an active Key2Benefits Visa Debit Card, please select this option to receive your first grant.

Direct Deposit

  • If you already have set up direct deposit, your first grant will be deposited directly into your account.
  • If you have not yet set up direct deposit, you may do so at your orientation appointment.
  • The processing time for deposits is a minimum of two business days and deposits are not made on non-banking days.

Debit Card

  • If you already have an active Key2Benefits Visa Debit Card, your first grant will be deposited directly into your Key2Benefits account.
  • If you do not have an active Key2Benefits Visa Debit Card, have lost your card, you may complete the form at your orientation appointment so that one may be ordered.
  • The processing time for deposits is a minimum of two business days and deposits are not made on non-banking days.

W – 9: Request for Taxpayer Identification Number and Certification

  • To add individuals as a vendor, QIN Finance is required to have a current W – 9 on file.
  • If you have never completed a W – 9 or if your name and/or mailing address has changed, you will be required to complete a W – 9 before your payment can be processed.
  • The required information is highlighted and must be completed before sending to QIN Finance.