Reimbursement Request Form
This form is for anyone who is NOT on Gusto, such as interns, YES members, or volunteers, and Board members, when they incur an expense on behalf of Skate Like a Girl. Upon submission, your reimbursement check will be processed. Your check will arrive to you within 3 weeks time, so be on the look out of a plain white envelope. If you do not receive your reimbursement within a month, please contact info@skatelikeagirl.com.
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
Confirmation Email
example@example.com
What are you requesting reimbursement for?
*
Items purchased
Mileage
What items were purchased?
What were the items purchased related to?
Example: Balloon decor for Get on Board fundraiser
Receipt of items purchased
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What was the purpose of this trip (these trips)?
Example: Deliver skate gear back to office from school program site
How many total miles were driven (round trip)?
Total amount reimbursement requested:
*
If there were multiple purchases or trips driven, total it all up & include that amount here. To calculate mileage (TOTAL MILEAGE Driven x 67 cents)
Include a screenshot of your route(s):
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Submit
Should be Empty: