Beth Shalom Reimbursement Form

Beth Shalom Reimbursement Form

Please complete all information so that we may reimburse you for your expenditure. Purchases that are $1,000 to $5,000 require a completed form that contains the authorization of the treasurer; purchases that are greater than $5,000 also require completion of a separate form that contains authorization from the Executive Committee. If you have questions or need to complete a different form, please contact the finance officer at finance@bethshalomnc.org.

Make Check Payable to:*

First NameLast Name

E-mail*

Preferred Phone*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Expenditure

Please complete the following information about your purchase(s).

Purchases*

Submitting your Receipt

Please submit a copy of your receipt. The receipt must be legible and must be a duplicate of the original receipt.

Upload Receipts*

Upload a File

All receipts must be readable and duplicate the original receipts