Reimbursement/Payment Request Form

All payments will be made by check. We do not have an online option for payment.

Instructions:

Please fill out completely with the description of reimbursement and breakdown of expenses
Attach up to five files/pictures/scans of all receipts and supporting documentation
A receipt of your submitted request will be e-mailed to you (please keep for your records)
The treasurer will email you when your check is ready to be picked up or has been mailed to you
Questions? Please e-mail our treasurer at lcctreasurer@gmail.com

Payment to be made to:

If you would like payment mailed, please add the address in this field.

How should the check be delivered (reset)

Please mail to vendor/payee Please send home from school with my student Please drop it off at my house Please mail to my house I will pick it up from the treasurer

Description/Purpose

Total Amount Requested for Reimbursement/Payment

Committee/Event*

Invoice Number (if applicable)

Attach Reciept/Invoice #1

Attach Receipt/Invoice #2

Attach Receipt/Invoice #3

Attach Receipt/Invoice #4

Attach Receipt/Invoice #5

Date Payment Needed (please allow 1-2 weeks if possible