Reimbursement Request Form

Name*

First

Last

Email*

Vendor: Refers to the organization/business that was paid by the employee completing this request.*

Purpose: Refers to the reason for the purchase. (Ex.) Tape for studio floors, office supplies, or signage for the Mad Hot Competition*

This purchase was approved by _____________________. Purchase approval is required for all reimbursements.*

Upload File: To complete the reimbursement request, all transactions require proof of purchase. This may include but is not limited to receipts or email confirmations with the Vendor name, total, and purchase date listed.*

Amount to be reimbursed*

Upcoming Payroll Date*

Is this a recurring reimbursement? *

Yes

No

Additional Information