STEP Tennessee Reimbursement Form

STEP Tennessee Request for Reimbursement Form
Please submit this Request for Reimbursement within 30 days of completion of an approved project. The following documents must be submitted along with the Request for Reimbursement:
- Form W-9 (Taxpayer Identification Number and Certification)
- Copies of all invoices for all eligible expenses
- Proof of payment in full, in US dollars, for all eligible expenses
- Proof of project completion
Company Information
Business Name*
Authorized Representative*
Authorized Representative Title*
Authorized Representative Email*
example@example.com
Authorized Representative Telephone*
Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Website Address*

Project Details
Please check the type(s) of project that you have completed:*

Export promotion services through the U.S. Department of Commerce, U.S. Commercial ServicesInternational Website OptimizationMarketing Media DesignTrade Show ExhibitionOther
Please describe the completed project including the products and/or services involved in this project*
Project Completion Date*

MonthDayYear
Date

What specific country(ies) did you target and/or connect with during this project?

Did this project result in any serious business leads?*

YesNo
Please Explain:*
Please describe your future export marketing plans that will build on this project
Please indicate the amount of ACTUAL export sales (in dollars) that were realized as a result of this project.*
Please estimate the amount of FORECASTED export sales (in dollars) you hope to achieve as a result of this project within the next 12-18 months?*
Please indicate the number of jobs your company hopes to retain or add due to increased exports in the next 1-2 years?
Number of jobs added*
Number of jobs retained*

Project Expenses
Total project cost ($)
Total reimbursement request (75% of project cost $)
Please check to make sure the following documents are uploaded with your Request for Reimbursement*

REQUIRED: W-9 Form (Request for Taxpayer Identification Number and Certification) Note: Reimbursement cannot be processed without this form.REQUIRED: Copy of final invoices to your company (with proof of payment) for all expenses claimed as eligible under STEP.REQUIRED: Proof of payment, in full, by your company for all expenses claimed as eligible under STEP. If not U.S. dollars, please convert and provide proof of any calculations.REQUIRED: Proof of project completion (e.g., report from service provider, link to website that was optimized for international commerce, copy of marketing materials produced, photo of exhibit booth, etc.)
Upload the above required files*

Cancelof
Authorized Representative*

First NameLast Name
Authorized Representative Title*
Signature*

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Date*

MonthDayYear
Date
For more information or assistance, please contact:
Jeffret Overby, Director, Tennessee Export Initiative, TEl@belmont.edu
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STEP Tennessee Request for Reimbursement Form