Request for Reimbursement of Funds

Name*

Who should we make the reimbursement cheque out to?

First Last

Email:*

Phone:*

Event or Item:

Please include details ie: Jane Doe Workshop on, or photocopying for …

Date of Event or Purchase:

Committee:

Which committee’s budget does this expense come from?

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Budget Line Number:

Amount:

Total amount of reimbursement in CDN - use https://wise.com/gb/currency-converter/usd-to-cad-rate/history

Please attach your RECEIPTS

Requested amount must match receipts.

Drop files here or

Accepted file types: jpg, gif, png, pdf, Max. file size: 64 MB, Max. files: 10.

Mailing Address:

Please include your mailing address if cheque is to be mailed.

Street Address Address Line 2 City Province Postal Code

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Comox Valley Unitarian Fellowship