25-26 Reimbursement Request Form

Instructions:

Please fill out completely with description of reimbursement and breakdown of expenses.
Attach up to 5 complete requests and attach reimbursement receipts and supporting documentation.
- If you have more than five requests, please separate your reimbursement requests so our team can keep everything together. We need complete records of each request and to also keep all expense accounts correct.
A receipt of your submitted request will be e-mailed to you (please keep for your records).
The treasurer will e-mail you when your check is ready to be picked or has been mailed to you.
Questions? Please e-mail our treasurer at treasurer@sequoyaapt.com.


NEED MORE DETAILS?
Review All Reimbursement Details Here

REQUEST INFORMATION:
Name Company Name (if applicable) Email: How would you like to receive your reimbursement*

FOR ZELLE REIMBURSEMENTS:
Phone Number and/or Email We need the phone number and/or email linked to your Zelle account. Please provide what name your Zelle is listed under so we can ensure we have the correct account.

FOR MAIL/PICK UP REIMBURSEMENTS:
Check made payable to: Mailing Address:

REIMBURSEMENT DETAILS:
Grand Total Amount Requested for Reimbursement/Payment: Date Check Needed (please allow at least 1-2 weeks if possible + additional time if mailing option is chosen):

REIMBURSEMENT #1
Amount Requested for Reimbursement #1 Committee/Event Description/Purpose: Expense Catagory* Attach Receipt/Invoice #1 Attach Receipt/Invoice #1 Attach Receipt/Invoice #1

REIMBURSEMENT #2
Amount Requested for Reimbursement #2 Committee/Event Description/Purpose: Expense Catagory Attach Receipt/Invoice #2 Attach Receipt/Invoice #2 Attach Receipt/Invoice #2

REIMBURSEMENT #3
Amount Requested for Reimbursement #3 Committee/Event Description/Purpose: Expense Catagory* Attach Receipt/Invoice #3 Attach Receipt/Invoice #3 Attach Receipt/Invoice #3

REIMBURSEMENT #4
Amount Requested for Reimbursement #1 Committee/Event Description/Purpose: Expense Catagory* Attach Receipt/Invoice #4 Attach Receipt/Invoice #4 Attach Receipt/Invoice #4

REIMBURSEMENT #5
Amount Requested for Reimbursement #5 Committee/Event Description/Purpose: Expense Catagory* Attach Receipt/Invoice #5 Attach Receipt/Invoice #5 Attach Receipt/Invoice #5

MORE THAN 5 REQUESTS?
If you have any additional receipts, please complete this form again. Please ensure your Grand Total requested reflects the Receipts you have submitted on this form.