Travel and Expense Reimbursement Form

2025 Travel and Expense Reimbursement Form
All expenses should be submitted within 2 (two) weeks of travel/expenses for reimbursement.

You must submit all original, itemized receipts for your expenses. Digital receipts are allowed. An acceptable itemized receipt is a document that includes each of the items listed below:
1. Transaction date
2. Name of merchant
3. Transaction details (what was purchased)
4. Form of payment used (cash, credit, debit)
5. Amount of purchase
6. Indication that the amount was paid
For mileage / tolls submit proof of mileage with Google Maps (or other appropriate application showing mileage). You may use E-Z Pass reports for any tolls.
Legal Name*

First NameLast Name
Phone Number*
Format: (000) 000-0000.
E-mail*

Confirmation Email
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Board of Directors / Committee Position*
Program / Purpose of Expense Report*
Are you requesting reimbursement under NJ Swimming's Officials Reimbursement Program?*

YesNo
If you answered yes above, what meet did you work?
Meet Start

MonthDayYear
Date
Meet End

MonthDayYear
Date
Preferred Method of Payment*

Zelle (please ensure the email address above is enrolled in Zelle)Mailed Paper Check (please ensure the address above is accurate)
Expense Details
Expenses List
Expense Total ($)
Travel List
Upload Receipts Here*

Cancelof
Any additional comments?
I certify*

I certify that all information entered above is valid and true.
Signature*
Should be Empty:

2025 Travel and Expense Reimbursement Form

Expense Details