Payment request form
Use this form to request reimbursement for approved League expenses, or to have a payment sent to a vendor or partner. Submit one form for each event, purchase, or payment request. Questions? Email treasurer.wheatonlwv@gmail.com .
Name of person requesting payment
*
First Name
Last Name
Email
*
example@example.com
Select payment request type:
*
Reimbursement for approved League expense
Payment to a vendor, contractor, or partner to support official League business
Other
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Reimbursement for approved League expenses
Provide the following information to request reimbursement for approved League expenses that you have already paid with personal funds.
Expense type
*
Please Select
Programs and Activities (GOTV)
Travel and Conventions
Membership Expenses
Fundraising Expenses
Meeting Expenses
Select what the purchase was in support of. Select only one.
Budget category
*
Please Select
Programs and Activities
Travel and Conventions
General Admin
Operating Expenses
Grant
Special Memorial Funds
Select which budget line the purchase should come out of. Select only one.
Which Grant is the expense towards?
Enter name of Grant
Which Special or Memorial Fund is the expense towards?
Enter name of specific fund
Date of expense
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Select the date the purchase was made.
Event title / purpose
*
Provide the name of the event, or the purpose of the items purchased on behalf of the League.
Description of purchase
*
Describe what was purchased and where it was purchased. Include quantity (if applicable).
Amount you are requesting to be reimbursed:
*
Ensure that documentation aligns with your request.
Where would you like your payment sent?
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Payment to a vendor, contractor, or partner to support official League business
Provide information so that a check can be mailed to the vendor, contractor or partner.
Expense type:
*
Please Select
Programs and Activities (GOTV)
Travel and Conventions
Membership Expenses
Fundraising Expenses
Meeting Expenses
Select what the good or service was in support of. Select only one.
Budget category:
*
Please Select
Programs and Activities
Travel and Conventions
General Admin
Operating Expenses
Grant
Special Memorial Funds
Select which budget line the payment for the good or service should come from. Select only one.
Which Grant is the expense towards?
Enter name of Grant
Which Special Memorial Funds is the expense towards?
Enter the name of the fund
Date of service
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Select the date the goods or services were delivered.
Event title / purpose:
*
Provide the name of the event, or the purpose of the items purchased on behalf of the League.
Description of goods or services received:
*
Describe what goods or services were received.
Amount requested for payment:
*
Enter amount of invoice. Amount must align with documentation.
Name of vendor, as it should appear on check:
*
Enter the vendor name (or business name) exactly as it should appear on the check.
Where to send payment?
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Other payment request type
Describe your payment request. Upload all supporting documents on next page.
*
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Documentation upload
Upload your receipts, invoice, or communication related to the amount requested. Your documentation must match the amount you are requesting for reimbursement.
File Upload
*
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