Check Request/Reimbursement Request Form

Instructions:

Please fill out completely with description of reimbursement and breakdown of expenses.
Attach up to 3 files/pictures/scans of all receipts and supporting documentation.
A receipt of your submitted request will be e-mailed to you (please keep for your records).
Our treasurer will e-mail you when your check is ready to be picked or has been mailed to you.
Questions? Please e-mail our treasurer at rsc.sr.treasurer@gmail.com

Check made payable to:

Should the check be mailed directly to the vendor/payee or would you like to collect it in person?*

Total Amount Requested for Reimbursement/Payment:

Committee/Event

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):