Chapter Expense Reimbursement Form.xlsx.xlsx
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ABCDEFGHIJKLMNOPQRSTUVWXYZ
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Los Angeles County Bicycle CoalitionName:
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634 S. Spring St. Suite 821
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Los Angeles, CA 90014Email:
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Phone 213.629.2142
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Facsimile 213.629.2259Phone:
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www.la-bike.org
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LACBC Local Chapter EXPENSE REIMBURSEMENT FORM
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Method of Reimbursement
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____Paypal ID: ________________________________
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____Mail check
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Name to appear on check: Address:
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Purpose of expense:
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____Other: ___________________________________
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Special Notes:
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DateExpense
e.g. Ralphs: groceries
Expense Category - consultant fees/office/supplies/printing/volunteers (only one category per expense, please)
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Item total
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Total:$
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Please attach all ORIGINAL receipts and mail to Jesi Harris.
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For faster transation, scan receipts and email them with the form first and mail originals promptly.
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Email: Jesi@la-bike.org
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Mail: LACBC Attn: Jesi Harris, 634 S Spring St. #821, Los Angeles CA 90014
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If you have any question about the reimbursement, please email or call Jesi 213-629-2142 (ext. 118)
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SUBMITTED BY:
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Print NameSignatureDate
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APPROVED BY:
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(Chair or Treasurer)
Print NameSignatureDate
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