Check Request/Reimbursement Request Form (2+ vendors)

Instructions:

Please fill out completely with description of reimbursement and breakdown of expenses.
Attach a file/picture/scan of each receipt or supporting documentation.
A receipt of your submitted request will be e-mailed to you (please keep for your records).
Please let us know if you would prefer Zelle or for a check to be mailed to you
Questions? Please e-mail our treasurer at memmingerptotreasurer@gmail.com

Name:

Grand total amount for reimbursement:

How would you like to be paid? Zelle or check?*

Phone number or email address associated with Zelle account

Address if check is to be mailed

Vendor

Expense category*

Amount