**REQUEST FOR CASH ADVANCE/REIMBURSEMENT**

**(McGovern-Dole)**

TO: Director

Programming Division

USDA/Foreign Agricultural Service

STOP 1034

1400 Independence Avenue, SW

Washington, DC 20250-1034

FROM: (YOUR NAME - must be a person with signing authority)

(YOUR ORGANIZATION)

(YOUR STREET ADDRESS)

(YOUR CITY, STATE, ZIP CODE)

DATE: (Date of your request)

SUBJECT: Agreement Number. \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_,
Budget Number \_\_\_\_\_\_\_\_\_\_\_\_\_, Country
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

In accordance with the above referenced Agreement and Budget, we hereby
request the amount of \$\_\_\_\_\_\_\_\_\_\_\_\_\_. These calculations
are based on the table below wherein funds requested for administrative
costs are indicated by \"admin,\" funds for internal transportation,
storage and handling, are indicated by \"ITSH,\" and funds for
activities that enhance the effectiveness of the program are indicated
by \"Projects.\"

+----------+-----------+----------+-----------+-----------+-----------+
| **Ca     | **Total** | **Less** | **S       | *         | **Ending  |
| tegory** |           |          | tarting** | *Amount** | Balance** |
|          | **A       | **Pr     |           |           |           |
|          | pproved** | evious** | **        | **Re      |           |
|          |           |          | Balance** | quested** |           |
|          | *         | **Adva   |           |           |           |
|          | *Budget** | nce(s)** |           |           |           |
+----------+-----------+----------+-----------+-----------+-----------+
| Admin    |           |          |           |           |           |
+----------+-----------+----------+-----------+-----------+-----------+
| ITSH     |           |          |           |           |           |
+----------+-----------+----------+-----------+-----------+-----------+
| ###      |           |          |           |           |           |
| Projects |           |          |           |           |           |
+----------+-----------+----------+-----------+-----------+-----------+
| *        |           |          |           |           |           |
| *Total** |           |          |           |           |           |
+----------+-----------+----------+-----------+-----------+-----------+

Please **wire** transfer the funds requested above to the following bank
account:

#### Bank Name: Your Bank 

Street Line 1: Bank\'s Street Address

Street Line 2:

City, State & Zip: Bank\'s City, State and Zip Code

Wire Transfer Number (ABA):

Account Name:

Account Type:

Account Number:

Tax ID Number:

Page -2-

USDA/FAS/PD

Agreement Number: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Request for (please circle one) 1st 2nd 3rd 4th 5th Cash
Advance/Reimbursement

I hereby certify that the above information is correct and in accordance
with the U.S. Government regulations and the bank account listed above
is this organization\'s account.

## By: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Date: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Title:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\--(USDA
APPROVAL
BELOW)\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\--

Date Received: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Concurrence:

# PD Analyst \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Date: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

PD Deputy Director \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Date: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_