Projects & General Operating Reimbursement/Check Request
In order to receive reimbursement for any expenditures this form must be completed. If completed by the last day of the month, a check will be ready at the following month's general meeting (i.e. form completed by January 31, receive check at February general meeting).
Your Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Project/Event Name
*
Purpose of Expense
*
Amount Requested
*
I would prefer
*
Check to be picked up at the next monthly meeting
Send through PayPal. (Put PayPal email in "Make Check Payable to: Box"
Check to be mailed
Pick up from Treasurer (Hayley Smith 601-297-3875)
No pickup needed. Charge made with JA debit card.
Make Check Payable To:
*
Please enter vendor name here if purchase was made using the JA debit card.
Mailing address for check to be sent:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Any additional information needed for check (i.e, account #, name of client, memo)
Upload Photo of Receipt
Browse Files
Don't forget to click SUBMIT below.
Cancel
of
This reimbursement request is Project related.
*
Yes
No
If your reimbursement is project related please complete the information below.
Has your expense been cleared by your project chair?
Yes
No (Please clear with your chair prior to submitting your reimbursement request. )
If your expense has been cleared, please enter the project chair/ JA member's name that cleared the expense.
Project/Event Date
-
Month
-
Day
Year
Date
Brief description of the project/event
Approximate # of children/families served
Feedback or Comments for 1st VP/Self Eval/Project Finding
Submit
Should be Empty: