Reiumbursement Request Form
Reimbursements can only be given if the budget and refund is approved by the chapter.
Soror First Name *
Your answer
Soror Last Name *
Your answer
Amount to be Reiumbursed *
(In U.S. Dollars)
Your answer
Store or Vendor *
Where were these items purchased?
Your answer
Date of Purchase *
MM
/
DD
/
YYYY
Itemized receipt and copy given to Grammateus and Tamiochus *
Reiumbursment cannot be given if receipt or bank statement is not providen
Required
Reason for this purchase *
Your answer
List the items purchased and their prices. *
Put each item on its own line.
Your answer
In what form would you like your reimbursement? *
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.
Your answer
E-Signature *
By signing and submitting this document you agree that all of the above information is true in accordance to the chapter's bylaws.
Your answer
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