Reimbursement Request Form

Instructions:

1. Fill out completely with description of reimbursement and breakdown of expenses by budget category (missing info will delay payment). Attach one file with copies of all receipts, preferably a PDF.
2. Specify if you prefer payment via Zelle (fastest) or check and respond to corresponding follow ups for payment info
3. REMEMBER – Our organization DOES NOT PAY SALES TAX on items purchased for its use; therefore sales tax will not be reimbursed
4. A receipt of your submitted request will be emailed to you (keep for your records)


Reimbursement Information




If requesting payment by Zelle


If requesting a check, please write who to make it out to






Expense 1 for Reimbursement



Add all for multiple purchases




Expense 2 for Reimbursement



Add all for multiple purchases




Expense 3 for Reimbursement



Add all for multiple purchases



Please attach one file with copies of all receipts




Approval






Treasurer's Notes

(to be completed by the Treasurer)