Expense Reimbursement Form
This form must accompany any request for reimbursement from HHS Athletic Booster Club.
Please list the receipts separately with a full description of items purchased and total the reimbursement amount you are requesting at the bottom of the column.
To receive reimbursement, you must submit this claim within 30 days of the expenditure.
Date:
*
/
Month
/
Day
Year
Date
Requested By:
*
First Name
Last Name
Email:
*
Your E-mail Address
Sport/Activity/Event/Budget Category:
Make Check Payable to:
*
Payee Address:
Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Back
Next
Itemized Expenses
Date
Vendor/Supplier
Description of Items Purchased
Amount ($)
1
2
3
4
5
6
7
8
9
10
Total Due ($):
Receipt(s):
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Requestor Signature:
*
*
I certify that all information entered above is valid and true.
Questions? Email HHS Athletic Booster Club Treasurer at hibritenboosterstreasurer@gmail.com
Submit
Should be Empty: