New 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:
- A request for reimbursement on your company's formal letterhead, including your company name and address, date, a short description of scope of work, and an itemized list of expenses, in US dollars
- 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 (a proof of payment can be a bank statement, credit card statement or wire transfer confirmation, with charges highlighted)
- Proof of project completion (e.g., a picture of your booth in the case of a trade show or copies of your marketing materials in the case of marketing media design).
Company Information
Business Name*
Authorized Representative Telephone*
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
Did this project result in any serious business leads?*

YesNo
Please Explain:*
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 due to increased exports from this project in the next 1-2 years.*
Please indicate the number of jobs your company hopes to add due to increased exports from this project in the next 1-2 years.*
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: A request for reimbursement on your company's formal letterhead, including your company name and address, date, a short description of scope of work, and an itemized list of expenses, in US dollars.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*

Powered by Jotform SignClear
Date*

MonthDayYear
Date
Note:

After review of the expenses, reimbursement will typically take 2-4 weeks to process. A company may also receive a 1099 tax form in connection to this grant.

Also, as agreed upon in your original application, you will be expected to provide export sales and job data related to your STEP funding every six months for up to two years. This data will allow us to track the return on investment (ROI) for our office and for the Small Business Administration.

For more information or assistance, please contact:

Jeffret Overby, Director, Tennessee Export Initiative, TEl@belmont.edu
Should be Empty:

STEP Tennessee Request for Reimbursement Form

Company Information

Project Details

Project Expenses