LGHS Reimbursement Form

LGHS Reimbursement Request
Date

MonthDayYear
Date
Your Name*

First NameLast Name
Your Email*
example@example.com
Your Phone Number*
Please enter a valid phone number.
Group
Is this reimbursement payable to you or to someone else?*

Payable to mePayable to someone else
Payee Name:

First NameLast Name
Payee Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Your Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Number of Receipts
Up to 5 receipts may be submitted using this form.
Receipt #1: ENTER AMOUNT
Receipt #1: What was the expense for?
Receipt #2: ENTER AMOUNT
Receipt #2: What was the expense for?
Receipt #3: ENTER AMOUNT
Receipt #3: What was the expense for?
Receipt #4: ENTER AMOUNT
Receipt #4: What was the expense for?
Receipt #5: ENTER AMOUNT
Receipt #5: What was the expense for?
Total Reimbursement Owed to Payee:
Upload a receipt for each expense. Receipts are required for expense reimbursement.

Cancelof
We make every effort to process requests within 15 days.

You can submit this form electronically if you are able to scan receipts and upload them. If not, print and complete the form, and:
- Leave your form and receipts in the locked Music Booster box outside the music office in the Music Building.
- Mail your form and recipts to: Los Gatos Music Boosters, PO Box 1638, Los Gatos, CA 95031
Due to mail or office pickup times, it may take longer to generate a check.

Improper requests (piles of receipts, email to the Boosters requesting checks, etc) will take longer and may not be honored.
Should be Empty:

LGHS Reimbursement Request