Goochland Band Boosters Reimbursement Request
Request reimbursement for approved band-related expenses. Please fill out all sections and attach required receipts.
Make Check Payable To
*
First Name
Middle Name
Last Name
Suffix
Email
example@example.com
Date of request
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Expenses List
*
Rows
Purchase Date
Store/Venue
Cost
Product/Service Description
1
2
Total Cost ($)
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Approved Purchase in Budget?
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Yes
No
If Yes: Line item in budget
If No: Date of Board Approval for this purchase
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Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Address to send check (if not picking up in person)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Invoice and/or receipts attachment
*
Upload a File
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Choose a file
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of
Signature of person requesting reimbursement
*
Please verify that you are human
*
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