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PERSONAL FUNDS REIMBURSEMENT FORM

TO:	WOU Business Office	Date:	_____________________________
FROM:	__________________________________________________________________________________
Please reimburse:	________________________________	V#:	_____________________________
Address:	__________________________________________________________________________________
	___________________________________	______________	_____________________________
	City	State	Zip

PURPOSE OF EXPENDITURE:	________________________________________________________________
	________________________________________________________________

CHARGE TO THE FOLLOWING FOAPAL(S):
Index #	Account #	Activity #	Amount

1. Index number(s), account number(s), and amount(s) are REQUIRED for each type of expense.
2. List activity code if needed.
3. Original receipts MUST be attached.
4. Form must have one signature other than person to be reimbursed.

Signature of person to be reimbursed

Department Head (Other than requestor)