Social Good Fund Request for Payment- Reimbursement
Use this form to submit a reimbursement request.

YOUR REQUEST WILL BE PROCESSED WITHIN 5 BUSINESS DAYS. YOU WILL RECEIVE AN EMAIL CONFIRMING THAT THE TRANSACTION HAS BEEN PROCESSED.

You can submit up to ten receipts for reimbursement for the same person with this form.

A receipt must be included with each request for reimbursement.

This form is mobile friendly and makes submitting receipts for reimbursement easy when using a mobile device. Simply upload a photo of the receipt from your cell phone/ipad, etc.., no scanning necessary!

WARNING: DO NOT USE YOUR BROWSER'S "BACK" BUTTON. YOU WILL LOSE ALL YOUR INFORMATION!

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Email address *
Your Phone Number *
In case we have questions about your request.
Your Name *
Your Project's Name *
Name of Person Being Reimbursed *
Total Amount to be Reimbursed *
The sum total of all the receipts being submitted for reimbursement. A maximum of 10 receipts may be submitted with this form.
Fund Source for Payment
If your project has multiple revenue streams, which revenue source should this reimbursement be paid from? For example, "XYZ Foundation" or "Unrestricted Funds", etc... If you have only one pot of funds, say "Unrestricted"
Are any of the items being reimbursed for considered a FIXED ASSET? *
A FIXED ASSET is Any material item that has a value of $2,000 or more, including (but not necessarily limited to): computers, furniture, hardware, tools, software or other tangible items and that has a useful life greater than 1 year.
If Yes to the previous question, please describe the item(s)
In your description, you must include the following as applicable: the value of the item; the item's make/manufacturer, model and year; any other information that will help understand the specifics of the item. For example: "$2,500, 2018 Dell Laptop Model #324..." or "$3,000, 2018 Ikea Florknork Work Station Desk and cabinet."
Are any of the items being reimbursed for considered a LOBBYING EXPENSE? *
Your answer should be "NO" unless you have previously discussed your lobbying activities with SocialGood and been given express permission to engage in lobbying activities.
Special Instructions or Requests?
Any special instructions or requests?
Form of Payment *
Please note: For initial setup of electronic funds transfer please allow 5 business days.
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