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LPGA Amateur Golf Association - Chicago Metro Chapter
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Payment and Reimbursement Request
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Please print or type and submit completed form and attachments to the Chicago Chapter Treasurer (Treasurer@lpgaamateurschicago.com)
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Attach invoices, receipts, etc.
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Request Date:
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Requested by:
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League & Course OR Event Name:
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Session Number:
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Cost Per Person:
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# Players:
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Total Cost $:$0.00
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Deposits Already Paid:$0.00
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Total Remaining $:$0.00
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REQUEST FOR PAYMENT BY CHECK
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Request should be submitted at least 2 weeks in advance of event to ensure delivery.
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Course or Vendor Name:
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Payee Name (if different than course/vendor)
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Address:
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Phone Number:
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Contact Person:
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Email Address of Contact Person:
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Date(s) of Play or Event:
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Amount Due $:$0.00
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REQUEST FOR PAYMENT BY ZELLE
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Payee Name:
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Street Address:
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City, State, Zip:
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Phone Number
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Zelle Account email or phone number
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CategoryDescription of ExpenseAmount
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(ex. Golf or Event name, League Name & Session)
(ex. Golf fees, deposit, food, prizes, other)(receipts attached)
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 $ -
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I certify that the above request relates to official, authorized business of LPGA Amateur Golf Association - Chicago Metro chapter
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 and the information is accurate to the best of my knowledge.
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SignatureDate
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