ERPA Reimbursement Form

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After you submit your request for supplies at https://bit.ly/erpa-request and receive approval, please fill in this reimbursement form and email receipts (photo or pdf) to ERPA's Treasurer at erpa@lefkowitz-law.com.

If there are multiple receipts, please include an itemized list. Thank you!

The shortcut to this page is https://bit.ly/erpa-reimburse

Name *

Email or contact *

Date Purchased *

YYYY

Vendor name *

Description / Purpose (briefly, but if multiple vendors, please itemize) *

Amount to be reimbursed *

These funds were used only to further the protection of East River Park and to directly meet ERPA's mission (advocate for interim flood protection, mitigation and oversight of the ESCR plan), and not for personal use nor for electioneering or political activity. *

Yes

Other:

Will you send in the receipt(s) upon submission of this form? *

I will email receipts to erpa@lefkowitz-law.com and include '$$ - ERPA' in the subject line.

I'm including receipts from multiple people and I will make sure each of them is reimbursed

Other:

Required

ERPA can reimburse me by: *

Paypal

Check

ACH

Other:

Please reimburse this email / contact that is associated with selected payment method *

When I receive the reimbursement, I will reply and acknowledge that it's received (for ERPA record keeping) *

Yes

Other:

Submit

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