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Reimbursement Request Form
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Name: Date:
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Address:
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DateDescriptionSupplier Amount
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Total Amount $ -
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Is this purchase included in the budget?
yes
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Discipline Approvals:
FAB Treasury:
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Date Received
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Check Date
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Discipline VPCheck Number
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Signatures Required*
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Discipline Treasurer
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All Checks over $1,000.00 require 2 Executive Board Member signatures. Discipline Approvals via e-mail are acceptable, please note that on the approval line and include a copy of the approval e-mail with the form.
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