Reimbursement Form – Stanislaus GOP – Republican Party of Stanislaus County

Full Name

First

Last

- I am a member of -

acknology Expense Event

Email Address

Date of Expense

Phone

Reason for request

Please provide information regarding your request.

- Please select a Retalated Event / Expense Category in drop down -

Please expain expense type

Expense

Description

Vendor

Date of expense was approved by the (RPSC)

Approved Amount

Budgeted

Yes
No
Unsure

Please upload any supported docs recieptsetc

Drag & Drop Files, Choose Files to Upload

Please provide a copies of any receipts

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.

Unauthorised expense

Authorized By (If applicable)

Authorized By Date

Approved By:

Approved By Date

Please Sign Below

Clear Signature

I acknology the information proved is accurate

I acknology the information proved is accurate