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ACFYHA Expense Reimbursement Form
Form to submit expenses to Association Treasurer for Reimbursement
Please use contact information for who check should be made payable.
Please allow up to 30 days for Reimbursement.
Email with questions.
Email address *
Name *
Address *
Phone number *
Expense Type *
Expense Description *
Reimbursement Amount *
Reimbursement Details (enter additional details here if multiple receipts)
Upload Itemized Receipt
A copy of your responses will be emailed to the address you provided.
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