Expense Reimbursement

Chapter Expense Reimbursement
Name of the person completing this form*

First NameLast Name
E-mail of the person completing this form*
Which chapter(s) will pay for this expense?
Chapter*
Has another chapter agreed to split this expense with you?*

YesNo
2nd Chapter
Reimbursement will be provided by cheque. Please tell us who should receive the cheque:
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How many receipts would you like to submit?*
Receipt #1
Reimbursement Amount*
Vendor*
e.g. Dollaramna
Brief description of items purchased*
e.g. Snacks and Pop
Purpose of items purchased*
e.g. Chapter Rush Program on 3/4/2018
Please Read Carefully: Please upload a scan or photograph of the itemized receipt (not the credit or debit receipt, but the receipt that includes the price of each item, the tax charged, and the total payment). If your receipt includes extra items that are not part of the reimbursement, please circle or highlight the correct items.
Receipt #1 Upload*

Browse Files

Cancelof
Receipt #2
Reimbursement Amount
Vendor
e.g. Dollaramna
Brief description of items purchased
e.g. Snacks and Pop
Purpose of items purchased
e.g. Chapter Rush Program on 3/4/2018
Please Read Carefully: Please upload a scan or photograph of the itemized receipt (not the credit or debit receipt, but the receipt that includes the price of each item, the tax charged, and the total payment). If your receipt includes extra items that are not part of the reimbursement, please circle or highlight the correct items.
Receipt #2 Upload*

Browse Files

Cancelof
Receipt #3
Reimbursement Amount
Vendor
e.g. Dollaramna
Brief description of items purchased
e.g. Snacks and Pop
Purpose of items purchased
e.g. Chapter Rush Program on 3/4/2018
Please Read Carefully: Please upload a scan or photograph of the itemized receipt (not the credit or debit receipt, but the receipt that includes the price of each item, the tax charged, and the total payment). If your receipt includes extra items that are not part of the reimbursement, please circle or highlight the correct items.
Receipt #3 Upload*

Browse Files

Cancelof
Total Reimbursement Amount
Total $
Should be Empty:

Chapter Expense Reimbursement

Receipt #1

Receipt #2

Receipt #3

Total Reimbursement Amount