Request for Reimbursement

Request for Reimbursement

This form must be completed in order to request reimbursement for approved Merion Village Association General Funds and Grant expenses. The MVA cannot issue reimbursement without this completed form and supporting documentation or for unapproved expenses. Please allow 7-10 days for processing.
Name of Payee*

First NameLast Name
Your E-Mail Address*
A copy of this request will be sent to you via e-mail.
Date by Which Reimbursement Check is Needed*

MonthDayYear
7-10 day processing...
Are Any of These Expenses Related to a Grant We've Received?*

NOYES
IMPORTANT: reimbursement requests related to a grant we've received must be submitted indepently of requests that relate to general MVA funds. If you need to request reimbursement from both grant and general funds, please complete and submit seperate forms.
Which Grant are These Expenses Related To?

Active Living: Community GardenActive Living: Pocket ParkUnited Way: Business DevelopmentUnited Way: Community GardenUnited Way: Historical MarkerUnited Way: Information Center RestorationUnited Way: Neighborhood BeautificationUnited Way: Pocket ParkUnited Way: Safety Education Program
Which Grant are These Expenses Related To?*
Total Reimbursement Amount Requested*
Complete Description of Expenses Included in This Request*
Receipts Included in This Request*
Upload ALL receipts related to the amount requested above. The amount requested cannot exceed the total expenses shown in the receipts. The MVA cannot distribute reimbursement without supporting documentation.
Receipts / Supporting Documentation*

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