Expense Reimbursement Form

Please ensure that your have approval from your committee chairman for this reimbursement before you submit this form.

Eleanor Mason

HBAA Treasurer

4108 Blossom Street

Houston, TX 77007

Treasurer@hba-aux.org

Date

Amount

Pay To the Order Of:

Mail Check to:

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Expenses: (Please attach any substantiating receipts or bills)

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Purpose:

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Amount:

Purpose 1

Amount 1

Purpose 2

Amount 2

purpose 3

amount 3

purpose 4

Amount 4

Total:

Opt-In

By checking above, I certify that I have approval for this reimbursement by my Committee Chairman. (Subject to verfication)

Signed and submitted by:

Committee or Office:

Phone

Approved By::

Committee or Office

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Please note : All In-KInd donations, money donations, and all donations of time should be reported below:

In-kind donation description

Click Here to Upload Receipts