SU72 Expense Reimbursement/SU Check Request Form

SU72 Expense Reimbursement/SU Check Request Form

Use form to request reimbursement or schedule payment directly to a vendor from GSHNJ Service Unit 72.
Name of Submitter

First NameLast Name
SU Position of Submitter
Submitter email address
example@example.com
Forms submitted by a Volunteer must be approved by another SU Team member, other than the Treasurer and SU Manager roles.
Enter applicable SU Committee
This request for an expense related to:
Enter reason for credit card refund:
Payment Gateway
Stripe sub-account
Attach a .pdf of the credit card transaction(s) from the payment gateway (from the Stripe sub-account developer access).

Browse Files

Cancelof
Event Name
Council Reporting Category
Purpose of Expenditure
Upload .pdf file(s) of all receipts associated with this payment request.

Browse Files
Limit 10 files. Cancelof
Do not include sales tax which could have been avoided with the use of the ST-9 form in the “Amount Requested” field.
Amount Requested
This spreadsheet is to assist you in adding up your reimbursed totals and is NOT required. Do not include $ in the amount column.
Payee

First NameLast Name
Business Name (if payee is business)
Email Address of Payee:
example@example.com
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Payment Delivery
Submitter is responsible for make specific arrangements with the SU Treasurer if Payment Delivery of "Other" is selected.
Name to contact for Debit Card

First NameLast Name
Phone to call for Debit Card

Area CodePhone Number
Date request submitted

MonthDayYear
mm/dd/yyyy
Additional comments
****SERVICE UNIT TEAM ONLY****
SU Member Review
SU Team Member?
SU Member Name

First NameLast Name
SU Member Review

MonthDayYear
mm/dd/yyyy
SU Member Signature
SU Member Approval Status:
SU Member Comments (required if denied)
SU MANAGER ONLY
SU Manager?
SU Manager Name

First NameLast Name
Date of SU Manager Decision

MonthDayYear
mm/dd/yyyy
SU Manager Approval Status
SU - Manager Comments (Required if Denied)
Confirm credit card refund total, if applicable
SU Manager Signature
Girl Scout Year
Should be Empty: