New England Region EXPENSE REIMBURSEMENT FORM
Budget Category_____________________________________
Date___________________________
Chairman___________________________________________ Check Amount $__________________
Make Check Payable to____________________________________________
Send Check to:
Name __________________________________________________________
Address _____________________________________________________
City/State/Zip_____________________________________________________
Expenditures:
Please check the box next to any single expenditure that exceeds $500. Attach a separate “Payment Authorized Form” For each such expenditure.
[] _____________________________________________ $ ______________
[] _____________________________________________ $ ______________
[] _____________________________________________ $ ______________
[] _____________________________________________ $ ______________
[] _____________________________________________ $ ______________
[] _____________________________________________ $ ______________
TOTAL $ ______________
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INSTRUCTION:
- Original invoices should be stapled to the back of this form.
- Chairmen may not exceed their budget without approval of the Finance Committee and the Executive Board.
- All invoices must be submitted prior to the end of the fiscal year.
- Keep a copy of this form and all invoices for your records
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