Reimbursement Request Form

Instructions:

Please fill out completely with description of the request for reimbursement.
Attach up to 3 files/pictures/scans of all receipts.
A receipt of your submitted request will be e-mailed to you (please keep for your records).
The treasurers will e-mail you when your check has been mailed to you or will be available to pick up at the next Boosters meeting.
Questions? Please e-mail our treasurer at treasurerduxboosters@gmail.com.

Check made payable to:

Name of person, organization or vendor to make check payable to.
Include mailing address if applicable.

Check Delivery*

Total Amount Requested for Reimbursement/Payment:

Category*

Description/Purpose:

Attach Receipt/Invoice #1

Attach Receipt/Invoice #2

Attach Receipt/Invoice #3

Date Check Needed (please allow at least 1-2 weeks if possible):