2025 F5F Mileage and Expense Reimbursement Form (Non-Employee)

First 5 FUNdamentals Initiative Mileage & Expense Reimbursement Form

Non-Employee
Name:*
Organization Name
Email Address:*
Phone Number:*
Event Attended *
Supporting Initiative (WCFC, PCECN, Family Connects, First 5 FUNdamentals) *
Date(s) of Event attended*
Mileage Reimbursement

Up to three trips can be entered below. Please use one section below per trip to enter information.

TOTAL Miles Traveled for Mileage Reimbursements:
Add Miles Traveled column for this total.
TOTAL ($) for Mileage Reimbursements:
Mileage reimbursement rate is calculated using current federal rate.
Meals, Travel, & Other Expenses

Up to three additional expenses can be entered below (such as flights, car rentals, bridge tolls, food, other misc. expenses, etc). Please use one section below per expense to enter information. Attach any receipts necessary for reimbursement.

Upload all receipts here. Please submit as .PNG, .JPEG or .JPG*

Cancelof
TOTAL ($) for Additional Reimbursements:
Add Total $ Amount per Expense column.
Total Reimbursement & Payment Method

Please complete the form here to see total reimbursement amount and confirm your preferred payment method.
GRAND TOTAL ($) for Mileage and Additional Reimbursements:
Please sign here to verify your reimbursement request.*

Clear
Print Name:*
Date Signed:*

MonthDayYear
Date
Preferred Payment Method:*

Direct Deposit/ACH (You will receive an email invite from BILL.com to enter your bank information if it is not already in our system)PayPalE-Gift card (Payment will be emailed through Tremendous.com)Mailed check (Mailed via BILL.com)
If you select "Mailed check" please provide mailing address below.
Is there any additional information you'd like to add about your reimbursement request?

Please press the green Submit button below to complete your reimbursement request.

Please allow 10-14 business days for your request to be processed.

Questions? Contact info@washingtoncfc.org or 253-682-1835.
Should be Empty:

First 5 FUNdamentals Initiative Mileage & Expense Reimbursement Form