Date____/____/____ Requested by:______________________________________
Phone:_____________________ Email:__________________________________
Committee:__________________________________________________________
Group / Project:________________________________________________________
Items Purchased / Description:____________________________________________
Group / Project:_____________________________________________________
Items Purchased / Description:____________________________________________
Committee Chair Approved:______________________________________________
Total Amount: $____________________ (Please attach receipts to the back of this form.)
Make check payable to (print):_____________________________________________ Address:_____________________________________________________________
Mail this approved, completed form with receipts to:
Vince Zardus
6964 E 78th Street
Tulsa, OK 74133
PLEASE NOTE:
All requests for reimbursement must be accompanied by this form, and approved
by the committee chair.
| URI:/reimbursement.shtml | Date Modified:Wednesday, 19-Jan-2011 10:12:26 EST | Saturday, 04-Feb-2012 19:23:45 GMT |