General Reimbursement Payment Request

INSTRUCTIONS: 1. This form is for Non-travel and Non-Entertainment reimbursement requests. Complete the Application section. 2. Receipts should be submitted no more than 45 days from purchase date. 3. Include an itemized receipt that displays payment method. 4. Submit the completed and signed hardcopy form with approval and attachments to Business Services in RM 311B. If submitting after 5pm, please place documents in envelope and drop off in RM 312 mail slot.