Woodrow Wilson IBPO

Reimbursement Form

1.  Please attach receipts and

2.  Submit to:  IBPO Treasurer @ wwibpo.treasurer@gmail.com

DATE:           __________________________________________________________

NAME:          __________________________________________________________

ADDRESS: __________________________________________________________

                       

                        __________________________________________________________

PHONE:       __________________________________________________________

E-MAIL:       __________________________________________________________

COMMITTEE:  _______________________________________________________

ITEM

Place of Purchase

AMOUNT

                                                                                 TOTAL:  _________________________

REMARKS:

Treasurer’s Notes

Date Received:          ____________        Date Paid:  _____________

Check Number:         _______         Amount:    _________________________

Treasurer’s Initials:  _______



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