Michiana Chapter, BMW CCA   Home Page   |   Contact Us

Reimbursement Form
(Revised 12/12/03)

Use this form to request reimbursement for expenses you incurred on behalf of the chapter. Print the form using your computer's printer. Contact Mike Harison if you have questions about this form (phone 269/684-6368 or via Email).

Name:__________________________________________________

Address:__________________________________________________

__________________________________________________

Phone/Email:__________________________________________________

Tell us which category best describes your expense. If you have expenses in multiple categories, tell us how much was spent in EACH category. Provide a brief explanation of what the chapter is purchasing (i.e., envelopes, flags, dinners, etc.). Unless specified, the treasurer will send you ONE check.

• STAPLE receipts to the BACK of this form. Receipts must support all expenses.
• Requests for $100 or less in any ONE category must have approval from at least one officer. Requests in excess of $100 must have the approval of TWO officers.
• Send your request to: Mike Harison, 700 Platt St. #23, Niles, MI 49120

Name(s) of officer(s) approving Requisition: __________________________________________________

Explanation of what the chapter is purchasing:__________________________________________________

Newsletter costs (INCLUDING Postage for Newsletter)
Postage (everything EXCEPT Postage for Newsletter)
Insurance
Driving School Expenses
Autocross Fees
Other Event Expenses... specify event:
Meeting Expenses
Telephone Expenses
Total >