O’Connor Company Co-op Claim Form
Submit your co-op claim. All entry fields and supporting documents are required.
Company Information
Company Name
*
O’Connor Account Number
*
Contact
*
First Name
Last Name
Email Address
*
example@example.com
Claim Details
Vendor Name
*
Brand Name
*
Vendor Invoice Number
*
Pre-Approval Number
*
Category
*
Please Select
Advertising
Events
Marketing Materials
Sales Promotion
Other
Activity Category
*
Please Select
Digital Advertising
Print Advertising
Trade Show or Event
Retail Promotion
Product Sampling
Other
Claim Start Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Claim End Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Claim Amounts and Supporting Documents
Total Activity Cost
*
Reimbursement %
*
Requested Amount
*
Supporting Documents
*
Upload a File
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Choose a file
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of
All claims must be submitted within 60 days of when the expense was incurred.
Completion of this form does not guarantee reimbursement. All approval guidelines still apply, and funds must be available.
Please submit all supporting documents. Any claims missing documents will not be processed.
Please verify that you are human
*
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