IORG Expenses Form
This can be used for any CT IORG Advisor that is requesting reimbursement for items they have purchased for an IORG event or activity
Payment Tracker
Person Sending/Writing the Check
First Name
Last Name
Date Completed
-
Month
-
Day
Year
Date
Check Number
Person Requesting Reimbursement
*
First Name
Last Name
Email Contact for Questions
*
example@example.com
Online or In-person Reimbursement
Online (Check Mailed)
In-Person (Check Given)
Address to Mail the Reimbursement to
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Event/Activity
*
Ex. Visatation
Date of Event/Activity
-
Month
-
Day
Year
Date
What items were purchased?
*
Reciepts from Purchase
Browse Files
Drag and drop files here
Choose a file
Add multiple items if they are for the same Event/Activity
Cancel
of
Total Reimbursement Requested
*
Comments
Submit
Should be Empty: