4H Club Expense (check request) Form
*Receipts must be scanned/submitted along with this form to request a check. If you are unable to scan receipts, you can print this form and mail or drop off the form/receipts to Shayla Reighter at 36702 State Road 52, Dade City, FL 33525.
Full Name
*
First Name
Last Name
Club Name
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Should the check be mailed to the address above or will it be picked up in office?
*
Mail to address above
Pickup in Office
Phone Number
*
-
Area Code
Phone Number
E-mail
*
Select all expenses that apply
*
Sales/Fundraising Supplies
Human Food
Animal Feed
Curriculum/Books/Copies/Postage
Program Supplies (not food)
T-Shirts/Apparel
Awards/Recognition
Travel Expense
Event Registration
Miscellaneous Expense
Description of Event
Total Sales/Fundraising Expense
Total Human Food Expense
Total Animal Feed Expense
Total Curriculum/Books/Copies/Postage Expense
Total Program Supply (not food) Expense
Total T-Shirts/Apparel Expense
Total Awards/Recognition Expense
Total Travel Expense
Total Event Registration Expense
Total Miscellaneous Expense
Total Expense
*
Please scan and attach all receipts here
*
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Receipts are required for check request
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