Expense Reimbursement Form

UVSA Gulf Coast used the Expense Reimbursement Form to process any reimbursements and pay invoices. It is highly encouraged to submit this form as soon as possible after your initial purchase. For any additional assistance, please email uvsagcpayment@gmail.com.

1

Receive Pre-Approval

All expenses must have been approved via the Expense Pre-Authorization Form. Only pre-approved items will be eligible for reimbursement except in unusual circumstances.

2

Complete the ERF

Fill out the form as accurately as possible. Scanned/digital copies of receipts, invoices, or any supporting documentation must be uploaded via the form for any items requesting reimbursement.

3

Approval Review

Your request will be reviewed by the treasurer. Allow up to twenty (20) business days for status updates.

4

Disbursement

The treasurer will issue a check and mailed to the address provided on the form. Allow up to five (5) business days after approval.

EXPENSE REIMBURSEMENT FORM

Reimbursements must be submitted within thirty (30) business days of purchase. Allow up to twenty (20) business days for processing. You will be asked to upload your receipts at a link provided at the end of the form.

Date

MM

DD

YYYY

Section 1: Contact Information

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Email

Phone

(###)

###

####

Have you been pre-approved via the "Expense Pre-Authorization Form"?

Yes

No

Section 2: Expense Information

Receipt #1 Itemized

Please list EACH item AND its quantity for which you are requesting reimbursement.

Receipt #1 Purpose

Please indicate the general purpose of each item purchased.

Receipt #1 Requested Amount

Please indicate the requested reimbursement amount from Receipt #1.

$

Receipt #2 Itemized

Please list EACH item AND its quantity for which you are requesting reimbursement.

Receipt #2 Purpose

Please indicate the general purpose of each item purchased.

Receipt #2 Requested Amount

Please indicate the requested reimbursement amount from Receipt #2.

$

Receipt #3 Itemized

Please list EACH item AND its quantity for which you are requesting reimbursement.

Receipt #3 Purpose

Please indicate the general purpose of each item purchased.

Receipt #3 Requested Amount

Please indicate the requested reimbursement amount from Receipt #3.

$

Receipt #4 Itemized

Please list EACH item AND its quantity for which you are requesting reimbursement.

Receipt #4 Purpose

Please indicate the general purpose of each item purchased.

Receipt #4 Requested Amount

Please indicate the requested reimbursement amount from Receipt #4.

$

Receipt #5 Itemized

Please list EACH item AND its quantity for which you are requesting reimbursement.

Receipt #5 Purpose

Please indicate the general purpose of each item purchased.

Receipt #5 Requested Amount

Please indicate the requested reimbursement amount from Receipt #5.

$

Receipt Upload

Email your receipts to eboard@uvsagc.org with the subject line "Reimbursement Request *Insert Date*". Please name your receipts accordingly i.e., Nguyen Receipt #1, Nguyen Receipt #2 etc.

Payee Information

Make Check Payable to:

List only ONE name or entity.

Total Requested Amount

Add the requested amounts from previous boxes.

$

Terms and Conditions

I understand that in order for check payment to be disbursed, digital documentation is required for all amounts listed above. If I have additional receipts to attach, I will submit an additional form with descriptions of those expenses and receipt attachments. Additionally, I understand that these expenses were approved by my supervisor (committee director, event chair, etc) and said expenses were budgeted. Lastly, I understand that expenses I made which were not approved will not be reimbursed and will be considered a donation to UVSA.

I understand and agree to the above terms and conditions.