Check/Reimbursement Request Form
Receipts or invoice must be attached!
Your Name
Phone
Today’s Date
Amount of Request
Description of Item(s) purchased:
Budget Category to be charged
Make check payable to:
Mail check to this Address:
Any Special Instructions:
Remember, to receive payment, a receipt or invoice must be attached
Questions: Call Carrie Casanas at 206-390-8469 or
e-mail at RJHTreasurer@gmail.com.
Treasurers
Notes:
Check #
Check Date
Date Mailed
Account
Charged