Check Request / Reimbursement Request Form
Submit this form after services are rendered -- when it's time to make payment. Submit each expense individually. The sum of all expenses submitted on a given day for a given project will be calculated and presented to Gale Patron, Allen Bomes and Jackie Gautreaux for approval.
Email
*
example@example.com
Name
*
First Name
Last Name
Purpose / Event / Description
*
Date of Spending
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Vendor
*
Amount
*
Receipt / Invoice Upload
*
Browse Files
Drag and drop files here
Choose a file
Photos of receipts MUST BE CLEAR -- taken with good lighting and all text in the receipt must be legible.
Cancel
of
Out-of-Budget Explanation
If the expenditure on this request was not pre-authorized or if the total exceeds the pre-authorized amount by 10% or $100 (whichever is greater), please explain.
Additional Comments
Submit
Should be Empty: