Expense Reimbursement Form

* : required

Type of Request:* Expense Reimbursement – (You purchased something and need to be reimbursed directly.) Invoice Payment – (A vendor provided an invoice for a product/service and payment needs to be made directly to the vendor.)

Pay to:*

Address:*

City:*

State:*

Zip Code:*

Email Address:*

Phone Number:

Amount:*

Reason:*

Requested by:*

Approved by (name of board member who approved the request):*

Upload photo of receipt here:

Upload invoices here or other documents here:

Please select preferred payment for your reimbursement:* PayPal Physical Check

If you selected PayPal above, please include the email address associated with your PayPal account.:

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