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Payment Request Form (one per check requested)
       
Requested by: Email:
       
Authorization: Phone:
       
Total Amount: $ Date Needed by: DD/MM/YYYY
       
Check Payable to: Address:  
       
Type of Payment :  Delivery:
       

Item # Date Incurred: Explain: Expense / Asset / Pass Thru Pass on / Allocate to: Amount
1
    $
       
2
    $
       
3
    $
       
4
    $
       
5
    $
       
6
    $
       
7
    $
       
8
    $
         
Comments / Details:       
       
     

Instructions:

Please fill out one request per check required.

If not a board approved or budget item, you must get prior approval from JLYSL president or JLYSL treasurer.

Identify if this is to be paid to you for expenses you paid up front (reimbursement) or paid direct.

Itemize each expense / asset purchase telling us the date the expense happened, who paid to, what reason, whether it is an expense or an asset purchase, etc. If this is to be passed on to another club or person, please indicate that in the field called pass on to / allocate to. If this is to be allocated to office expenses (for example) put office expenses in this field.

Put any explanations in the comments field.

Please send original receipts to PO Box 24251, Oakland CA 94623.