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Attach Original Receipts Here (no copies)

Financial Reimbursement Request Richland Waves DATE OF REQUEST: ___________________ REQUESTOR’S NAME: ________________________________________________________________ Print Clearly Please REASON FOR EXPENSE: ______________________________________________________________ Budget Item: Office Supplies

$______________________

Concessions

$______________________

Heat Sheets

$______________________

Other: _____________________________________________

$______________________

TOTAL REIMBURSEMENT REQUEST

$______________________

Total

SIGNATURE OF REQUESTOR: _____________________________________________________

ALL CHECK REQUESTS MUST BE ACCOMPANIED BY ORIGINAL RECEIPTS.___ ANY REQUEST OVER $100 REQUIRES PRIOR APPROVAL BY THE RICHLAND WAVES SWIM TEAM EXEC BOARD.

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