HOPE Reimbursement Request Form (26)

Reimbursement Request Form

Submit your expense reimbursement with supporting documents for review.
Requester Information
Full Name

First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Role with HOPE
Date of Request

MonthDayYear
Date
Reimbursement Details
Total Amount Requested
Date of Purchase

MonthDayYear
Date
What was purchased or paid for?
What event, program, or project was this for?
Budget Category
Was this expense approved in advance?
Who approved the expense?
Receipt Upload
Upload Receipt(s) / Proof of Payment

Cancelof
Additional Supporting Documents

Cancelof
Payment Information
Who should the reimbursement check be made out to?
Mailing Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Would you like the check mailed or picked up?

Other
Notes about payment
Certification
I certify that this expense was for HOPE-related business
I certify that the information submitted is accurate
I certify that this expense has not already been reimbursed
I understand that submitting this form does not guarantee payment until the request is reviewed and approved
I understand that I cannot approve my own reimbursement request
Internal Use Only — Approval & Payment Processing

Internal-use only. To be completed by a HOPE board member, officer, treasurer, or authorized staff member after submission.
Reviewed By
Staff / Board Member Approval
Treasurer / Board Member Approval
Approval Date

MonthDayYear
Date
Approved Amount
Payment Status
Check Number
Check Date

MonthDayYear
Date
Check Signed By
Internal Notes
Should be Empty:

Reimbursement Request Form

Requester Information

Reimbursement Details

Receipt Upload

Payment Information

Certification

Internal Use Only — Approval & Payment Processing