Submit Receipt

A receipt shows amount of payment and how the payment was made (last 4 digits of credit card or cash). Please don’t submit a packing list. Invoices to be paid can be submitted ... please check the appropriate box.

Not quite sure how to categorize something? Use this document as guidance. If you make a payment in Amazon or Office Depot online, please use the same document to document the order PO number.

One submission of this form per purchase. Please don't photocopy multiple receipts on the same piece of paper or try to cover multiple purchases with the same submission of this form. Thanks!
Purchaser (not necessarily the person submitting this form)*

First NameLast Name
Date of Purchase*

MonthDayYear
Date
Payee*
From whom was the product or service purchased. Or if deposit this is who is paying us. (no commas in this field, please)
Please provide details of purchase:*
Please check all that apply:

Reimburse me because I bought this with my own fundsInvoice attached which needs to be paidThis is a deposit
How would you like to be reimbursed?

Reimburse me with checkReimburse me via Zelle
File Upload

Cancelof
Addition Notes
Initials of the person submitting the form if other than person who made the purchase.
Submitter Email Address*
example@example.com