Instructions for Use of this Form:

Request for reimbursement must be submitted within 10 working days after purchase is made or request may be denied.

Prior approval of site administrator or business office must be obtained before the purchase is made.

Staple original receipts and/or register tapes to the reimbursement form. Reimbursement will not be made without receipts.

District cannot reimburse expenditures made with gift cards.

Amazon orders are not eligible for reimbursement. All Amazon orders must be processed through the District Office.

Purchases made over the internet are discouraged if items can be bought elsewhere using a purchase order issued through

the District Office. Reimbursement requests for internet orders must include a copy of the sales order, verification of payment

(original copy) and a packing slip signed by employee verifying that items were received. Online orders must be delivered

to the district's business address, not to the home address of employee purchasing the item(s).

REIMBURSEMENT PAYABLE TO:

PRIOR APPROVAL FOR PURCHASE WAS OBTAINED FROM:

TOTAL REIMBURSEMENT REQUEST

I hereby certify that the above is an accurate accounting of my incurred expenditure(s).

Signature of Person Claiming Expense Reimbursement

Site/Program Administrator Approval

Business Office Approval