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
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Itemized Expenses
Rows
Date
Vendor/Supplier
Description of Items Purchased
Amount ($)
1
2
3
4
5
6
7
8
9
10
Total Due ($):
Sales tax paid ($):
*
(If no sales tax paid then enter 0)
Receipt(s):
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Requestor Signature:
*
*
I certify that all information entered above is valid and true.
Questions? Email HHS Athletic Booster Club Treasurer at hibritenboosterstreasurer@gmail.com
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