LTJBSA Expense Form

LJTBSA Expense Reimbursement Form

Please allow 5 days for reimbursement to be paid.
Today's Date

YearMonthDay
Date
Your Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Reimbursement Type*

Zelle (to phone number or email address above)CheckOn LTJBSA Card, no reimbursement

Expenses

	Date	Vendor	Classification	Item Description	Amount($)	Notes
1
2
3
4
5
6
7
8
9

Receipts must show vendor name, date of purchase, and amount paid.*

Please use your camera phone to take pictures of all paper receipts for upload. If you do not include a receipt you may not be reimbursed for an expense.
Cancelof
Signature*

Clear
Summary
Expenses
Should be Empty: