Expense Form

REIMBURSEMENT
There is a process to be followed when you want the branch to spend money. It starts by filling out a REQUISITION form.

A requisition form must be submitted and approved before a reimbursement can be issued.

USE THIS FORM TO:
- Request reimbursement for an expenditure paid with personal funds
Branch Committee/Event*
Committee, Event, Program, etc.
Date Submitted*

MonthDayYear
Date Required

MonthDayYear
Amount Requested*
Was purchase/service use pre-authorized?*
Pre-authorization is required for any reimbursement.
If purchase was not pre-authorized, why?
CHECK PAYABLE TO
Name*
Full Name
Address

Street Address

Street Address Line 2

CityState

Zip Code
Memo line
Mail Directly to Payee*
If No, the check will be mailed to the program/event lead.

Expenses List*

	Purchase Date	Product/Service Description	Cost
1
2
3
4
5

Attach Receipts Here

Browse Files
Upload a receipt for each expense Cancelof
Total from Expense list*
Automatically calculated from Expense List
Does total match Amount Requested (above)?*
If amounts do not match, why?
I certify*

I certify that all information entered above is valid and true.
Signature (Constitutes as your electronic signature)*

Clear
Full Name*
Email*
example@example.com
Please verify that you are human*
Heading
NOTICE:

The check must be approved by vote of the membership in an official meeting or by the Executive Committee. Attach all receipts and/or invoices related to this request. Proper documentation is required. Request will not be processed for payment until all required information is received. Please submit request one week prior to the reimbursement date. Circumstances beyond our control may cause a check to be delayed. We appreciate your patience with these delays.
NAACP Willingboro & Vicinity Branch
P.O. Box 3088
Willingboro, NJ 08046

https://www.naacp-willingboro.org
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REIMBURSEMENT