Print this page and complete it. Bring it to the shop for the Treasurer Mail Box.

WOODCHIPS

THE SCA WOODWORKING CLUB

REQUEST FOR REIMBURSEMENT OF CLUB EXPENSE

Member’s Name (print): __________________________________Amount: $____________

Expense Description:___________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Vendor: __________________________________________Purchase Date: _____________

I certify that on the above date, I spent the above amount for the listed items on behalf of the

Woodchips Club using my personal funds. Accordingly, I request reimbursement from the Club

for this expenditure.

________________________________________ _________________ _________________

Signature Date Telephone

(Do not write below the line)

ACKNOWLEDGMENT OF PAYMENT

Paid to: __________________________________Amount: ___________Check # _________

Issued by: ____________________________________________Date: __________________

Treasurer

Received by: _______________________________________________

Signature