Reimbursement & Check Request Form

Instructions:

Consolidate submissions into one, if possible.
Fill out form completely with budget/expense category, description of reimbursement or payment and breakdown of expenses (if applicable).
Attach up to 3 files/pictures/scans of all receipts and supporting documentation.
A receipt of your submitted request will be e-mailed to you (please keep for your records).
Please allow 1-2 week for processing. If a rush, make arrangements with the treasurer.
You will receive a receipt for your submission. If you don’t, it wasn’t completed.
Questions? Please e-mail Jenny@zettermanfamily.com or elkhornridgeboosterclub@gmail.com.

First Name Last Name Email Address email address Should the check be mailed directly to the vendor/payee?* Check made payable to: Check Mailing Address: Total Amount Requested for Reimbursement/Payment: Committee/Event #1* Please indicate the Committee / Expense type on the form. Committee/Event #2 Committee/Event #3 Description/Purpose: Please share a brief description: Attach Receipt/Invoice #1 Attach Receipt/Invoice #2 Attach Receipt/Invoice #3 Date Check Needed (please allow at least 1-2 weeks if possible):

Information Below - Treasurer Use Only
Approved By: Approval Date: Date Check Issued: Check Number: Check Amount: Notes: