Check to Be: Mailed Only Include Address If Mailed

PAYEE INFORMATION: Whether the check is to be mailed or picked up, your address MUST be provided. Please note there is a $10 minimum to process.

Check to be: / ð Held at 25 Main Street (you will receive an e-mail when ready) ð Mailed
Address (required): / Apt #: / City: / Zip:

Charge Account Information:

Vendor: / Cash & Carry ð / SaveMart/FoodMaxx ð / Collier Hardware ð / Approval to use Charge Account:
(Supervisor Signature à)

REIMBURSEMENT INFORMATION: Please number all receipts at the top (i.e. 1, 2, 3, etc.) in date order. Your request will not be processed until all fields are complete.

Receipt
# / Project / Object / Date of Receipt / Date of Event / Event Description/Use
(All non-food Items must meet the allowability check-list) / Location of Event / Total $ / Actual # of Attendees (Impressions) / Planned
# of Attendees / $ / Planned Attendee (Cannot exceed $2.50) / Field/ Office
Office Use
TRAVEL INFORMATION: Mileage (round miles to nearest whole number) Travel Expense Claim
Project / # of Miles / $ Amount / Project / # of Miles / $ Amount / Project / % / $ / Project / % / $

Complete and attach the Research Foundation “Monthly Mileage Log” or “Travel Expense Claim” forms and all receipts if mileage or conference is being claimed.

** If you are claiming mileage, please make sure that your mileage log is signed and dated - mileage logs must be signed to process payment.

Receipt
# / Project / Date of Receipt / Date of Event / Event Description/Use
(All non-food Items must meet the allowability
check-list) / Location of Event / Total $ / Actual # of Attendees (Impressions) / Planned
# of Attendees / $ / Planned Attendee / Field/ Office
Office Use Only