Reimbursement Request – Stanislaus GOP – Republican Party of Stanislaus County

Expense Reimbursement Request

First Name

Last Name

I am a

Of District

I am a Alternate of

Phone/Mobile

Date

Reason for request

Please provide information regarding your request.

Please select a Retalated Event / Expense Category in drop down

Please expain expense type

Description

Date of expense was approved by the (RPSC)

Budgeted

Yes

Unsure

Vender

Approved Amount

Requested Amount

Please upload any supported docs recieptsetc

Choose File

Not Approved By RPSC

If you are seeking payment for an item not approved at a meeting, please provide the information below, as payment under these circumstances is not guaranteed and requires more research.

Authorized By (If applicable)

Approved By:

Authorized By Date

Approved By Date

I acknology the information proved is accurate