VICTORY MARTIAL ARTS

Reimbursement Request
School Name*
Employee Name*
Email:*
example@example.com
Submission Date*

MonthDayYear
Reimbursement Submission Date
Total Reimbursement*
How Many Receipts?*

1 to 56 to 1011 to 15
Please ensure that all fields are completed for the refund to be accepted.

Vendor: store name
Date

MonthDayYear
School Location Name
Exp Type
Vendor
Amount
Date

MonthDayYear
School Location Name
Exp Type
Vendor
Amount
Date

MonthDayYear
School Location Name
Exp Type
Vendor
Amount
Date

MonthDayYear
School Location Name
Exp Type
Vendor
Amount
Date

MonthDayYear
School Location Name
Exp Type
Vendor
Amount
Date

MonthDayYear
School Location Name
Exp Type
Vendor
Amount
Date

MonthDayYear
School Location Name
Exp Type
Vendor
Amount
Date

MonthDayYear
School Location Name
Exp Type
Vendor
Amount
Date

MonthDayYear
School Location Name
Exp Type
Vendor
Amount
Date

MonthDayYear
School Location Name
Exp Type
Vendor
Amount
Date

MonthDayYear
School Location Name
Exp Type
Vendor
Amount
Date

MonthDayYear
School Location Name
Exp Type
Vendor
Amount
Date

MonthDayYear
School Location Name
Exp Type
Vendor
Amount
Date

MonthDayYear
School Location Name
Exp Type
Vendor
Amount
Date

MonthDayYear
School Location Name
Exp Type
Vendor
Amount
Payment Method*

ZelleBank Account
Zelle Information
Zelle Display Name:*
Enrolled email address or mobile number:*
Bank Name:*
Account Holder Name:*
Account Number:*
Routing Number:*
Upload ALL receipt copies*

Cancelof
**Must upload receipt copies

**All Reimbursements are processed on Friday's. Please submit by Thursday latest to have it processed by Friday.

Thank you!!!
Signature*

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Reimbursement Request

Please ensure that all fields are completed for the refund to be accepted.

Vendor: store name

Zelle Information