Michiana Chapter, BMW
CCA 
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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 Eve Dolenski if
you have questions about this form (phone 269/969-7492 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: Eve Dolenski,
Name(s) of
officer(s) approving Requisition:
__________________________________________________
Explanation
of what the chapter is purchasing: __________________________________________________
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Newsletter costs (INCLUDING Postage for Newsletter) |
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Postage (everything EXCEPT Postage for Newsletter) |
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Insurance |
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Driving School Expenses |
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Autocross Fees |
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Other Event Expenses... specify event: |
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Meeting Expenses |
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Telephone Expenses |
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Total > |
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