Oregon Coastal Quilters Guild

Check Request or Expense Reimbursement

Committee Name

(Committee name)

Expenses for (month[s]):

Item purchased	Where Purchased	Purchased By	Cost of Item**
Total of Purchases : $

*Request Submitted By: ________________	Date: _________

Requesting Member’s Signature	M/D/Y

*Request Approved By:	Date: _________

Committee Chairman’s or Officer’s Signature	M/D/Y

*Requester and Approver may not be the same person

Date request paid:	Check paid to:

M/D/Y	Member’s or Vendor’s Name

Check number:

**ATTACH RECEIPTS TO REQUEST FOR REIMBURSEMENT!!

Keep a copy for committee’s records.

Revised 02/04/2018

Nan Scott

2018-02-06