Expense Reimbursement or Payment Request

Please complete the following form; you should receive your reimbursement check in 7-10 business days.

Request Type *

Please select the request type. If you would like to donate the item(s) purchased in lieu of being reimbursed, please select the third option.

Check payable to: *

First

Last

Address to send the check to: *

Address Line 1

Address Line 2

City

State

Zip Code

Total amount requested:

Describe Please purchased:

Describe the item(s) purchased: *

Budget to Charge *

If "Other," please describe:

Please upload a scanned / photographed copy of your receipt(s): *

Click or drag files to this area to upload. You can upload up to 6 files.

If you are unable to upload a copy of your receipt, please contact Isaac at FinanceManager@OUUC.org to coordinate.

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