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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)