Reiumbursement Request Form
Reimbursements can only be given if the budget and refund is approved by the chapter.
Soror First Name
Soror Last Name
Amount to be Reiumbursed
(In U.S. Dollars)
Store or Vendor
Where were these items purchased?
Date of Purchase
Itemized receipt and copy given to Grammateus and Tamiochus
Reiumbursment cannot be given if receipt or bank statement is not providen
Yes (Bank Statement)
Reason for this purchase
List the items purchased and their prices.
Put each item on its own line.
In what form would you like your reimbursement?
Electronic (quickest option)
Cash (allow additional time for this option)
Email or phone number associated with your PayPal account
All electronic reiumbursments will be submitted via paypal at no additional cost to the chapter or soror. Contact your Tamiochus if would like help setting up a personal PayPal account.
By signing and submitting this document you agree that all of the above information is true in accordance to the chapter's bylaws.
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