Payment Request Form (multiple budget categories)

PAYMENT REQUEST FORM (MULTIPLE BUDGET CATEGORIES)

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).
Please note if your check is to be mailed to the vendor

Payment requests are fulfilled on a weekly basis. Payment requests for checks must be submitted by Monday at noon to be ready for pickup on Friday morning

Questions? Please e-mail our treasurer at treasurer@okepta.org.

As always, please remember: As a sales tax exempt organization, we cannot reimburse sales tax, so please give all vendors a copy of our sales tax exemption form to avoid being charged sales tax when you make your purchase. No sales tax will be reimbursed without prior approval.

Make check payable to:

Grand total amount for reimbursement:

Would you like to pick up the check or have it mailed to your home (the address on your contact record)?*

Budget category*

Amount