Expense Reimbursement Form

Expense Reimbursement Form

Expense Reimbursement Form
Form Submitted by:

First NameLast Name
Name (check payable to) *

First NameLast Name
Instructions:
1. Expense must be submitted within 90 days with orginal reciepts/Invoice
2. Purchase must be approved by chairman prior to the transaction
3. Personal purshase should not be part of receipt/invoice
4. Please provide legal name and address, subject to verification
5. Receipt/Invoice clearly indicates date, legal name & amount
6. June expenes must be submitted before July 31st
7. Non-Profit tax-exempt should be applied, ask for ST-5 Tax Except Form
8. Vendor/Contractor/Resturant business must submit W-9 Form
9. Please allow up to 15 days for processing
Please Note:

Darul Islah employees, shura and sub committee members may submit expenses for facility maintenance work, event and school expenses
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Brief description of expense*

Expense List*

Rows	Date	Description	Category	Cost
1
2
3
4

Uploads all receipts & a valid ID (if first time)

Cancelof
Total Cost ($)
Expense Portfolio*
I affirm and certify that all information and supporting documents are accurate and authentic. I understand that false or misleading claims may result in rejection or delay.

Affirm
Once this expense is approved, you will receive an approval email. Please allow us up to 15 days from the approval for processing your reimbursement. For any questions or concerns, please email finance@darulislah.org
Signature*

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Approval Status

ApprovedDenied
Should be Empty: