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Binky Patrol Expense Reimbursement Request Form

General Information
Include Area Code

PLEASE make a copy of this report, receipts and/or donations for your personal records SEND IN ORIGINAL RECEIPTS ONLY. NO COPIES WILL BE ACCEPTED. IF YOU ARE REQUESTING REIMBURSEMENT FOR GIFT CARDS PURCHASED YOU MUST SUBMIT THE RECEIPTS OF HOW THEY WERE SPENT!

DONATIONS
(Attach copy of receipts given out)
Name Amount
1 $
2 $
3 $
4 $
5 $
6 $
7 $
8 $
9 $
10 $
Total DONATIONS(A) $
EXPENSES
( Original receipts for each expense must be attached. Use back of form for additional expenses, if necessary. Include all expenses in the total on front. An expense is NOT a gift card. Expenses include: fabric, yarn, batting,thread, etc. – things that make binkies and help run your chapter – not gas, dry cleaning, etc... )
Date Place of Purchase Description Amount
1 $
2 $
3 $
4 $
5 $
6 $
7 $
8 $
9 $
10 $
Total EXPENSES(B) $
Amount currently in your chapter account (contact BPHQ if unsure) $
Plus total amount from enclosed donations to your chapter (Line A) + $
Minus 20% of enclosed donations for deposit to BP National Account - $
New balance in account $
Minus requested expense reimbursement (Line B) $
Final balance left in your account $

I certify that the information provided is accurate. All submitted expenses are true chapter expenses and all funds donated to my chapter have been submitted to BPHQ.

PLEASE MAKE A COPY OF THIS FOR YOUR RECORDS BEFORE SENDING IN