Leigh PAPA Expense Reimbursement Form

Main instructions: Please complete each section below. Once completed, click the "Submit" button at the very bottom of this form. Incomplete or missing information will delay the processing of your reimbursement.

Enter Form Date*

Date

Select Form Type*

Your Information: Please enter your name and contact information.

Full Name*

Phone Number*

Area CodePhone Number

Email*

example@example.com

Preferred payment / reimbursement method:

ZellePaypalCheck by mail

Check Payable To:

Name / Company*

Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Please provide the email or phone number associated with the receipient's paypal account. Note: One of the two field are required for payment via paypal.

Email associated with the paypal account*

example@example.com

Phone Number associated with the paypal account*

Area CodePhone Number

Please provide the email or phone number associated with the receipient's Zelle account. Note: One of the two fields are required for payment via Zelle.

Email associated with the Zelle account*

example@example.com

Phone Number associated with the Zelle account*

Area CodePhone Number

Items Instructions: Please add your items to be reimbursed. Select an activity, enter a descritption, and enter an amount. For separate or multiple activities, click the "Add Item" button to add a new entry row. Don't forget to total up your item amounts and enter it into the "Total Amount" field.

Example #1: Reimbursement for $3.49 for hem tape for costumes for the spring musical. Select "Drama/Theater - Spring Musical", enter "Hem tape" in the Description field, enter "3.49" in the Amount field, and upload a picture or scanned PDF of your recipt.

Example #2: Reimbursement for $60.00 in gas to transport marching band students to Fresno and $20.89 for glue for props. Select "Marching Band - Transportation", enter "gas" in the Description field, enter "60.00" in the Amount field. For the glue, click the "Add Item" button. Select "Marching Band - Props", enter "glue" in the Description field, enter "20.89" in the Amount field. Don't forget to scan and upload your scanned PDF or picture of your recipts FOR BOTH ACTIVITIES.

Missing item information will delay the processing of your reimbursement.

For mobile phones, you may have to turn your phone sideways (i.e. landscape) to see the entire item row.

Item list (click "Add Item" to add a new item)*

Total Amount*

Add up your item amounts and enter the total amount to be reimbursed

Expenditure details, notes, or instructions:

Enter any other info or special instructions

File Upload Instructions: Select and upload all related documents in PDF, JPEG, or TIFF format. Please make your uploaded files readable for our review. Unreadble, Incomplete, or missing supporting documents will delay your reimbursement.

For web-based receipts, please enter the link in the "Web Links" field.

You can mix both types of receipts.

Select Files

Use this for file-based receipts

Web Links

Use this for web-based receipts

Requestor (your) Signature*

Use your mouse, finger, or stylus to sign

This area (below) is reserved for treasury & secondary approver signatures (2 signature boxes below). Requests for reimbursements $500 and over require a additional second board approval signature.

Treasury Signature

Use your mouse, finger, or stylus to sign

Treasury Approver Name

For treasury only!

Treasury Approval Date

Date

Misc Treasury Info

Second Approver Signature

Use your mouse, finger, or stylus to sign

Second Approver Name

For secondary only!

Second Approval Date

Date

Submit section: Complete the capcha and click the submit button to complete this request.

Enter the message as it's shown*