2019 PBF Expense Submission Form
NOTE: This is the *2019* expense submission form. If you are submitting a 2018 expense, please use the following form:


If you are submitting this on behalf of someone else, please enter *your* email address in the first section below and the *recipient's name* in the "Comments" section. For expenses requiring personal reimbursements, please also have the responsible elder sign the receipt before submitting.

Email address *
Expense Details
Vendor or Recipient *
The name of the company from which something was purchased -or- the payment beneficiary. If there are multiple companies, please enter each under a different expense submission.
Amount *
Please enter a positive number only, no dollar signs or commas. If there are multiple items, itemize each purchase under a new submission (only one receipt per submission).
Date of Purchase *
The date that the item was purchased.
Expense Category
Select from one of the expense categories in the drop-down menu below. For "uncategorized" options, please obtain the responsible elder's prior approval and signature before submitting.
Reimbursement or Remittance Required? *
Do we need to reimburse you, another member, or a company for this expense with a check? This is only required when not using a PBF debit card. If "yes", please provide details in the Comments section below including recipient, address, and phone number (if not listed in the member directory).
Comments or Justification (optional*)
*Only required for non-standard purchases or submissions requiring reimbursement. If you are submitting the form for a vendor or another member, please provide a name and any other important details here. A phone number and full postal address is required for companies.
Receipt Image
Submit a legible image of your receipt or invoice using a digital camera (such as your phone). PDFs and Word documents are acceptable too. NOTE: If a receipt is not yet available, you may submit the form without it and revise your expense submission at a later date using the "Edit" link in your confirmation email.
A note about submitting this form...
You should receive a confirmation message and email after clicking the "Submit" button below. If nothing happens after clicking this button, scroll up and make sure you've correctly completed all required fields. NOTE: Revisions to previous submissions are permitted using the "Edit" link from your confirmation email.
A copy of your responses will be emailed to the address you provided.
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