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  • Reimbursement Form

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    foxcitiesstars
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    ACES XAVIER EDUCATIONAL SYSTEM, INC. REIMBURSEMENT FORM To be completed by the individual seeking reimbursement: Name and Address of Individual Seeking Reimbursement are you an employee (circle)? Yes no date of purchase if "No", please enter Social Security number ________________ Amount Requested 1) Reason for purchase (this can be skipped if a PO was completed prior to the purchase) 2) Reason for reimbursement vs. The use of a PO for direct billing (this

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    ACES XAVIER EDUCATIONAL SYSTEM, INC. REIMBURSEMENT FORM To be completed by the individual seeking reimbursement: Name and Address of Individual Seeking Reimbursement are you an employee (circle)? Yes no date of purchase if "No", please enter Social Security number ________________ Amount Requested 1) Reason for purchase (this can be skipped if a PO was completed prior to the purchase) 2) Reason for reimbursement vs. The use of a PO for direct billing (this

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    Attribution Non-Commercial (BY-NC)
    Скачайте в формате DOC, PDF, TXT или читайте онлайн в Scribd
    Отметить как неприемлемый контент
    104 просмотров1 страница

    Reimbursement Form

    Загружено:

    foxcitiesstars
    ACES XAVIER EDUCATIONAL SYSTEM, INC. REIMBURSEMENT FORM To be completed by the individual seeking reimbursement: Name and Address of Individual Seeking Reimbursement are you an employee (circle)? Yes no date of purchase if "No", please enter Social Security number ________________ Amount Requested 1) Reason for purchase (this can be skipped if a PO was completed prior to the purchase) 2) Reason for reimbursement vs. The use of a PO for direct billing (this

    Авторское право:

    Attribution Non-Commercial (BY-NC)
    Скачайте в формате DOC, PDF, TXT или читайте онлайн в Scribd
    Отметить как неприемлемый контент
    из 1

    ACES XAVIER EDUCATIONAL SYSTEM, INC.

    REIMBURSEMENT FORM
    To be completed by the individual seeking reimbursement:
    Name & Address
    of Individual
    Seeking
    Reimbursement

    ________________________________________
    ________________________________________
    ________________________________________
    ________________________________________

    Are you an employee (circle)? Yes No


    Date of purchase

    If No, please enter Social Security number ________________

    _______________________

    Amount Requested

    $_____________

    1) Reason for purchase (this can be skipped if a PO was completed prior to the purchase)
    _________________________________________________________________________________________
    _________________________________________________________________________________________
    __
    2) Reason for reimbursement vs. the use of a PO for direct billing (this can be skipped if a PO was
    completed prior to the purchase)
    _________________________________________________________________________________________
    _________________________________________________________________________________________
    __
    Signature
    Date

    ________________________________
    ______________

    Please check one: ___ Mail Check


    ___ Return Check to Campus

    Please tape loose receipts to 8x11 pages and attach to this form. Submit this form to
    the campus secretary for processing.
    To be completed by the campus:
    Campus:

    __ St. Bernadette
    __ St. Pius X
    __ St. Joseph

    __ Catholic Central
    __ St. Thomas More
    __ Xavier

    __ Central Office

    If a PO was completed prior to this purchase, please attach the pink copy to this form and forward to Business
    Services for processing. Its fine if the vendor on the PO is not the individual being reimbursed.
    OR
    If no PO was completed, please verify that items 1 & 2 above are acceptable and complete the following. Then
    forward to Business Services for processing.
    Authorization of Principal __________________________________
    Amount Approved for Reimbursement $_________
    Account Number _________________________________________

    Form date: October 16, 2006

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