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Expense Reimbursement Form

Check Request and Expense Reimbursement Form (click here)
Check Request and Expense Reimbursement Form for use in Excel

GCFM, INC.

CHECK REQUEST/EXPENSE REIMBURSEMENT FORM

 

CHECK AMOUNT:                                                                  DATE:

 

BUDGET CATEGORY:                                                          CHAIRMAN:

 

CHAIRMAN SIGNATURE:

 

 

MAKE CHECK PAYABLE TO:

 

SEND CHECK TO:

 

ADDRESS:

 

PHONE NUMBER (Required):

 

 

EXPENDITURES:

 

Description

Amount

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TOTAL REQUESTED

 

 

 

 

 

CHECK # ____________DATE _____________ACCOUNT # ______________________

1.       All receipts must be stapled to this sheet (no loose paper).  Keep copies for your records.

2.      Provide a second copy of any contract or other material that is to be mailed with the check.

3.      Chairmen may not exceed their budgets without approval of the Finance Committee and the Executive Board.