Request for Reimbursement/Payment
Use this form to: obtain reimbursement for monies already spent on TBO supplies, equipment, etc. Reimbursements must be authorized by your Committee Chair or other authorized person IN ADVANCE. Please attach any receipts, bills, checks, estimates, etc.
Today's Date
*
-
Month
-
Day
Year
Date
Name
*
Name of person requesting
Email
*
example@example.com
Committee Name
*
I need
*
Please Select
reimbursement
check cut to pay for something
Authorized by
*
Name of Governing Board member or Committee Chair Person
I verify that I have pre-authorized this purchase/reimbursement with a Governing Board member or Committee Chair
*
Please enter printed name in lieu of signature
Back
Next
Item #1
*
Amount
*
$
TBO Account #
*
Please make sure to note the correct TBO account number. If you are unsure please contact your Committee Chair or Vice President.
Back
Next
Item #2
Amount
$
TBO Account #
Please make sure to note the correct TBO account number. If you are unsure please contact your Committee Chair or Vice President.
Back
Next
Item #3
Amount
$
TBO Account #
Please make sure to note the correct TBO account number. If you are unsure please contact your Committee Chair or Vice President.
Back
Next
Item #4
Amount
$
TBO Account #
Please make sure to note the correct TBO account number. If you are unsure please contact your Committee Chair or Vice President.
Back
Next
Item #5
Amount
$
TBO Account #
Please make sure to note the correct TBO account number. If you are unsure please contact your Committee Chair or Vice President.
Back
Next
Payment Information
Total Amount
*
$
Make check payable to:
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Payment Arrangements
*
I will contact the office to arrange pick up
Please mail to the address above
Back
Next
Receipts
I am
*
uploading my receipts below
emailing my receipts to office@templebethor.org
File Upload
Browse Files
Drag and drop files here
Choose a file
Please upload receipts here
Cancel
of
Back
Next
Check Information
Total Amount
*
$
TBO Account # of Fund
*
Reason for payment
*
There will be:
*
a letter accompanying this which I will send to the office
no letter needed - please mail payment ASAP
Make check payable to:
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Back
Next
Comments Questions:
Back
Next
Submit
Should be Empty: