Reimbursement Form

The purpose of this form is to simplify the Treasurer’s task to quickly provide reimbursement for preapproved / budgeted items.

If you would like reimbursement for your contributions to Club activities, you MUST fill out this form. Completed forms may then be printed and postal mailed to the Treasurer or submitted directly from this webpage. In either case, receipts must be attached!

Reimbursement Form

Requester’s Name

Today’s Date

Payee’s Info

Payee’s Name

Address

City, State, Zipcode

Phone Number

Format: (999) 999-9999

Activity Name

Activity Date

List of attached receipts & amounts

Click the [Add] button to add additional items to this request.

Reimbursement Item

Amount

File Upload

Maximum file size: 5MB

NOTE: Include only ONE (1) receipt with each line item. Click the “Add” button below to add more receipts for this request. Upload photos or scans of receipts, invoices, etc. here. Valid filetypes are: pdf, doc, docx, jpeg, png, xlsx, xlsb, ods

Add Remove

Total requested

Additional Comments:

Optional

Treasurer’s Use Only

Reimbursement Date

Check #

Amount

If you are human, leave this field blank.

Huggers

Rochester NY's Premier Outdoor Activity and Social Club

Reimbursement Form

Payee’s Info

List of attached receipts & amounts

Treasurer’s Use Only