Iia-st. Louis Chapter Payment Request/Expense Reimbursement Form



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IIA-St. Louis Chapter

Payment Request/Expense Reimbursement Form



Tawana Turner


Wells Fargo Audit Services

One North Jefferson Ave.

MAC H0003-034

St. Louis, MO 63103

Phone: (314) 875-1211

Fax: (314) 955-7124

tawana.turner@wellsfargo.com

Only for reimbursements over $500


TO:

John Drury


RubinBrown

One North Brentwood

St. Louis, MO 63105

Phone: (314) 290-3250

Fax: (314) 290-3400

John.Drury@rubinbrown.com

Please pay the following approved expense/reimbursement for the following chapter expense. ORIGINAL supporting documentation is attached. Please ensure the payment is received by ________________________.


See Attached

Pay to:


Name, Address and Phone __ __ _ ______________________

__ ______________________

__ ___________________________

__ __________________________


Description of Expenditure(s):

____________________________


G/L Account #: Amount: _________________

________________ _________________

________________ _________________

________________ _________________

TOTAL AMOUNT OF PAYMENTS: ____________

Was expense budgeted? _______________ YES ______________ NO

Other Special Instructions:_____________________________________

________________________________________________________________________


************************************************************************

Individual Completing Form: _______________ Phone: __________ Date: ________


Approved by Pertaining Officer: __________ Phone: _______ Date: ____________
Treasurer’s Approval:________________________________________ Date:_____________

(Required for transactions exceeding $500)

************************************************************************

Directions: Please complete the form. Attach original receipts or a copy of documentation approving the specific expense (i.e. requests from restricted funds given by the Education Foundation). Forward the form to respective officer for approval, G/L account distribution, and indication as to if the expense was budgeted. An attached FAXED approval from the officer is acceptable. Forward the entire voucher package to the address above. Please indicate the due date of the payment. If an electronic request form is sent and/or electronic approval is obtained, the supporting receipts must be received prior to payment.



IIA Payment Request/Expense Reimbursement Form (Revised 7/13/15)


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