CKI Reimbursement – SWD Kiwanis

CKI Reimbursement Request Form

First Name *

Last Name *

Email *

Phone *

Office *

Office

Request

Brief Description of Item *

Line Item * Line Item

Date Funds Were Spent *

Amount *

Add a Reimbursement Line Remove

Total Reimbursement Requested

Reimbursement By: *

VENMO

PAYPAL

CHECK

VENMO username *

PayPal username *

PayPal will take a fee from your reimbursement amount. The fee is your expense. Unfortunately CKI cannot reimburse the PayPal fee.

Accept PayPal Fee *

I accept the PayPal fee

I Do Not accept the PayPal fee

Because you have rejected the PayPal fee this reimbursement will not be submitted.

Make the Check to the Order of and Mail the Check to this Address *

Make the Check to the Order of and Mail the Check to this Address

first & last name

address

City

State/Province

Zip/Postal

File Upload

Maximum upload size: 516MB

APPROVALS

Governor

Treasurer

District Administrator James Phelps

SWD Ex. Director kenneth garley

Upon submission you, Governor Joshua Burgett, Treasurer Cielo Barrios, District Administrator James Phelps and Ex. Director kenneth garley will receive a copy of this reimbursement request.
Please give everyone a few (3-5) days to submit their approvals or request additional information. If your reimbursement request is rejected you will be contacted by the person making the rejection with an explanation.
Upon everyone's approvals the Ex. Director will pay.
If you do not receive an email copy of this request or payment takes more than ten days please follow up.

Type your name to represent your signature "/s/typed name" *