Request for Check Reimbursement by Trustee

Trustees, please fill out this form to be reimbursed for purchases made for use by DEF or to request a staff member be reimbursed for approved purchases made for a grant.

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

Trustee Name

Trustee Email Address

Check Recipient Name (if different)

Check made payable to:

Amount of Check for Reimbursement

Address to Mail Check (Street, City, State, Zip Code)

Expense Category

Description/Purpose of Purchase

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

Attach Receipt/Invoice #1

Attach Receipt/Invoice #2

Attach Receipt/Invoice #3

Attach Invoice/Receipt #4

Notes for Treasurer: