Request for Check Reimbursement by Trustee

Trustees, please fill out this form if you have purchased something on behalf of our organization and need to be reimbursed.

Instructions:

Please fill out completely with description of reimbursement and breakdown of expenses.
Click Save and Continue at bottom of form to submit. The DEF Treasurer and DEF President will receive an email of your request.
A receipt of your submitted request will be e-mailed to you. Please keep for your records.

Date of Request

Name

Email Address

Check made payable to:

Address to Mail Check

Expense Category

Description/Purpose of Purchase

Itemized List of Purchase(s) (include item(s), amount(s), quantity, where purchased, etc.)

Total Amount Requested for Reimbursement

Attach Receipt/Invoice #1

Attach Receipt/Invoice #2

Attach Receipt/Invoice #3

Notes for Treasurer: