Application for Expense Reimbursement (AER)

Application for Expense Reimbursement (AER)

AER forms begin processing on the first business day of each month. A representative will reach out if more information is needed. It is the responsibility of the applicant to ensure that all information is correct. Failure to do so may result in automatic rejections or delayed processing. If you need assistance completing this application, please reach out to the Office of the Treasury at treasurer@gulfcoastcampdelta.org.

Section I: Applicant Information
Name*

First NameMiddle NameLast Name
Organization Email Address*
Phone Number*
Format: (000) 000-0000.
Mailing Address*

Street Address

Street Address Line 2

CityState

Zip Code
Title/Role/Position Within Organization*
Supervisor Name*
Supervisor Organization Email *
Camp Delta Program (Typically General Staff, Camp Directors, etc.)Administration (Typically Board of Directors, Officers, Company Staff)Other

Section II: Reimbursement Method
Physical CheckDirect Deposit (EFT)
Terms and Conditions for a Physical Check Reimbursement

A physical check will be mailed to the address provided in Section I. Processing typically requires 7–10 business days on average. Each check is valid for 180 days from the date of issuance. Any check not deposited within this timeframe shall be deemed forfeited by the applicant. Forfeited reimbursements are not eligible for reapplication or reissuance. A $1.50 processing fee applies to each physical check issued. This fee will be deducted from the final approved reimbursement amount. Gulf Coast Camp Delta shall not be responsible for delays or losses caused by postal services or applicant error.
By signing my name, I acknowledge that I have read, understood, and agree to be bound by the Terms and Conditions for a Physical Check Reimbursement.*

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Direct Deposit (EFT) Information

Applicants are responsible for ensuring that all information submitted is accurate. Gulf Coast Camp Delta shall not be held liable for any misplaced funds resulting from typographical errors, inaccuracies, or omissions made by applicants.
Financial Institution*
Routing Number*
Confirm Routing Number*
Payee Name on Account*

First NameMiddle NameLast Name
Bank Account Number*
Confirm Bank Account Number*
- If you have a physical check, you can find your Routing Number and Bank Account Number on the bottom-left corner of your check. You can also find your information on any of your bank statements.
- Terms and Conditions for a Direct Deposit (EFT) Reimbursement
  
  The financial institution information provided in this Section will be used to issue Electronic Fund Transfer (EFT) payments for all approved claims payable to the listed payee. EFT payments may only be deposited into checking accounts. It is the applicant’s sole responsibility to ensure that all information provided in this Section is accurate. By signing this document, the applicant affirms that the information is true and authorizes Gulf Coast Camp Delta to transmit EFT payments to the listed account. Gulf Coast Camp Delta shall not be held liable for any losses, delays, or misdirected payments resulting from incorrect or incomplete account information, payee details, or contact information submitted by the applicant. In the event that an EFT payment is rejected, the Office of the Treasury will make up to three (3) attempts to contact the applicant via email, with each attempt spaced approximately five (5) business days apart. If the applicant fails to resolve the issue within five (5) business days of the third and final notice, the reimbursement shall be deemed forfeited by the applicant. Forfeited reimbursements are not eligible for reapplication or reissuance. A processing fee of $0.50 applies to each EFT payment. This fee will be deducted from the approved reimbursement amount.
- By signing my name, I hereby authorize Gulf Coast Camp Delta and its authorized agents to initiate a one-time electronic credit entry, and if necessary, to initiate credit adjustments or corrections to the account specified above for the purpose of issuing my reimbursement.*
  
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Section III: Receipt Uploads and Itemized List

Please upload a copy of each receipt corresponding to your expenses. All receipts must include at least a vendor name, a date of purchase, individual prices, and quantities. It is highly recommended that you highlight individual line items. Improperly labeled receipts and items will be automatically rejected. All expenses must be submitted within 60 days of purchase as indicated on receipt(s). It is highly recommended that receipt must be labeled with a unique display name to allow for easy identification in the next section. All receipts must include (1) a date of purchase and (2) individual prices and quantities. Card statements do not qualify as a valid receipt.
Use the box below to upload your receipts. *

Cancelof
Itemized Expenses

Please fill out the table below with each line item according to your receipt. Note that if you have more than 50 line items, you must submit another separate AER form.

Itemized Line Expenses

Rows	Item Name EXACTLY as Shown on Receipt	Item Description	Receipt Name	Expense Account	Qty	Price Per Unit	Subtotal
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50

Total Requested for Reimbursement
Verify that the total listed above matches expectations.

Section IV: Final Submission
Final AER Terms and Conditions

Submission of a form is not a guarantee of reimbursement. Upon approval, reimbursement payments will be made according to the preferences listed in Sections 1 and 2. By signing this document, you acknowledge that all information is correct to your knowledge and expenses have been approved by your direct supervisor.
Signature

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I certify that all expenses submitted are valid, accurate, and for official organizational business. I understand that falsification of this information may result in disciplinary action.
Date

MonthDayYear
Date
Should be Empty:

Application for Expense Reimbursement (AER)

Section I: Applicant Information

Section II: Reimbursement Method

Terms and Conditions for a Physical Check Reimbursement

Direct Deposit (EFT) Information

Terms and Conditions for a Direct Deposit (EFT) Reimbursement

Section III: Receipt Uploads and Itemized List

Itemized Expenses

Section IV: Final Submission

Final AER Terms and Conditions