Butte Valley Forms & Information

Butte Valley Pony Club
REIMBURSEMENT REQUEST FORM
Instructions:
1. Fill-out form completely
2. Provide copies of receipts
3. Submit completed form and receipts within 45 days of purchase to treasurer
NAME:_________________________________________________DATE:________________
ITEMS PURCHASED
Reason for purchase: __________________________________________________________
______________________________________________________________________________
Make check payable to: ________________________________________________________
In the amount of: ________________________________________________________
Send check to: ________________________________________________________
_______________________________________________________
Signature: _______________________________________________________
For Club Use:
Approved by:_______________________________________________________
Received date:__________________ Date paid:________________ Check #:____________
Quantity Description Cost Per Unit Total
TOTAL: