ECC Reimbursement Request
Complete this form if you have spent approved personal funds on planned or emergency purchases for ECC. Receipts can be given to the Treasurer, scanned and emailed to the Treasurer or a picture of receipt can be emailed to the Treasurer (Doug Burleson - dburleson40@gmail.com) . Please ensure all pertinent info is viewable in the picture.
Your Name *
Your answer
Today's Date *
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Date of Purchase *
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Store Where Purchase Was Made *
Your answer
Amount Of Purchase *
Your answer
Purpose Of Purchase/General Description Of Items Purchased *
Your answer
How Was This Purchase Approved? *
For Emergency Purchase, Name(s) of Board Members Who Also Approved Purchase
Your answer
Date of Approval *
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You Submitted Your Receipt To The Treasurer Via *
Required
Date The Receipt Was Submitted To The Treasurer *
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I attest that these funds were used only for the ECC organization and not for personal use and understand that I will be reported to all proper authorities should it be determined by the Board that funds were improperly used. I understand that the Board may not reimburse funds that were not properly approved or utilized. I also understand funds will not be reimbursed if a receipt has not been submitted successfully to and accepted by the Treasurer. *
Required
Your Digital Signature *
Your answer
Please Click On Next, Skip Past The Treasurer Section, Then Click Submit!
This form will not be submitted unless you click on Submit on the next page. Please do not complete any questions in the Treasurer section, they are stripped out of the responses.
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