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Indivisible LRCA Reimbursement Request
Use this form to submit a REQUEST FOR PERSONAL REIMBURSEMENT made on behalf of Indivisible LRCA.
You must submit a RECEIPT with this form (upload) or to the Treasurer in order to receive REIMBURSEMENT.
No Exceptions.
For any amount over $50, you must have submitted a completed the ILRCA PURCHASE REQUEST FORM confirming this expense has been approved by at least 3 COUNCIL MEMBERS.
Report may be submitted any time but MUST BE SUBMITTED BY THE END OF THE MONTH in which purchase was made.
Submit additional reports as needed. Thank you for supporting Indivisible Little Rock & Central Arkansas!
Email address *
Your First and Last Name *
Today's Date *
Has a PURCHASE REQUEST been submitted? *
Any PURCHASE over $50 must have the prior approval of at least three (3) Council members. Purchase Request:
Did the PURCHASE REQUEST have the required Council approval? *
Purchases over $50 must have prior approval.
Date of Purchase *
Enter the date on receipt
Classification of Purchase *
Select the category that best describes how the purchase will be used. You may only select one classification per form. If you have multiple classifications, please submit those expenses (with tax) with the corresponding classification each on their own form. The total of all submissions should be equal to the amount requested for reimbursement.
Description of Item/s Purchased *
Enter a description of the item. Examples of material goods: ream of paper, printer ink, posterboard, stamps, markers, snacks, drinks, etc. Examples of services: USPS, ZOOM, Social Media Boosts, website, etc. Also describe here if you are submitting multiple items in the same classification listed above.
Place of Purchase / Store Name *
Do you have the receipt? *
If you do not upload receipt here, please submit to Treasurer by the end of the month.
Purchase Price *
Other Information?
Provide any addition information regarding this request for reimbursement, including if the receipt entered will be used again for other submissions. THANKS!!
A copy of your responses will be emailed to the address you provided.
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