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Regional Expense Reimbursement Request Form
Regional Expense Reimbursement Form
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*
Date Format: YYYY slash MM slash DD
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*
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*
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Pay to you or to outside Vendor?
*
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Pay an outside Vendor
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*
Outside Vendor's name should appear on the invoice/receipt you're uploading.
Reimbursement Type Requested
*
Standard check by Mail (7-10 business days)
Zelle
PayPal
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Enter the email or phone # associated with your Zelle
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List all expenses incurred that need to be reimbursed
*
Description of Expense
Amount of Expense
Receipt upload
*
Drop files here or
Accepted file types: jpg, gif, png, pdf.
Upload a copy of your receipt(s)
*FINANCE COORDINATOR USE ONLY* Payment Status
Paid
*FINANCE COORDINATOR USE ONLY* Payment Date
Date Format: YYYY slash MM slash DD
*FINANCE COORDINATOR USE ONLY* Check # or Transaction #
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