Expense Reimbursement Form

APPROVAL IS REQUESTED FOR ITEM(S) SHOWN BELOW. THIS IS A:

Request for reimbursement for a [[Club Name]] business expense. Receipt(s) attached.

Claim for payment for authorized goods and/or services. Invoice(s) attached.

Line Item	$ Amount Paid (attach receipts)	Description of Expense	Expense Code
Automobile Fuel
Automobile Parking
Airfare
Taxi/Shuttle (with tips)
Hotel/Lodging
Meals (not including alcohol)
Registration Cost
Shipping/Postage
Supplies (itemize)
Other (itemize)
TOTAL

PLEASE SUBMIT ALL EXPENSES WITH RECEIPTS WITHIN 30 DAYS OF DATE INCURRED.

Mail to: [[CLUB TREASURER CONTACT INFO]]
Email to: [[CLUB TREASURER CONTACT INFO]]

Make check payable to:

Name:

Address:

City/State/Zip:

Date:

Requested by:

DISBURSEMENT AUTHORIZATION (to be completed by Club Treasurer and President)

Amount Approved: _______________ Check Made to:____________________________________

Expense Account Code: ___________ Line Item:________________________ Check #:________

Treasurer: _________________________________________________ Date:_________________

President: _________________________________________________ Date:_________________