Reimbursement Request

This form should be used for any reimbursement request ($10.00 or more) for garden expenses. In general these purchases should already be pre-approved by the Board. Requests will be reviewed, and if approved a check will be sent to the address provided below. For any reimbursement requests that are less than $10.00, please submit an email to gethsemanecommunitygarden@gmail.com.

Name *

First

Last

Email *

Mailing Address (For Check Payment) *

Address Line 1

City

State

Zip Code

Item 1 *

Minimum Price: $10.00

Item 2

Item 3

Total Amount For Reimbursement *

Item Quantity Qty Total

There are no products selected.

Item 1 1 $0.00

Item 2 1 $0.00

Item 3 1 $0.00

Total $0.00

Please Upload Receipt(s) For Reimbursement Review *

Drag & Drop Files, Choose Files to Upload You can upload up to 3 files.

Notes