Check Request | PLAY HHA Bentonville

REQUEST

CHECK

Please read before submitting a check request.

All expenses must be pre-approved by a member of the HHAB PO Board of Directors
Expenses must be accompanied by supporting documents that must include store specific information detailing each item and quantity purchased. Credit card slips, statements or canceled checks are not acceptable.
Expenses must be submitted within a reasonable period of time—no more than 30 days after the expense was incurred
Any amounts received in excess of the actual expenses incurred must be returned within a reasonable period of time—no more than 30 days after receipt of the excess money
Any goods included in this reimbursement request are the property of the HHA Bentonville Parent Organization. All items should be turned over to the HHAB PO immediately following the event the items are being purchased for—no more than 14 days after the event for which they were purchased

Requestor's Name(Required)

First Last

Phone(Required)

Email(Required)

Check Payable To(Required)

Check Disbursement(Required)

Address If Check Is Being Mailed

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Budget(Required)

Please select what line item in the budget this should go under.

Event Or Reason For Purchase(Required)

Itemized Purchases(Required)

Date of Purchase

Items Purchased

Place Purchased

Price

Total(Required)

Receipts

Please upload supporting documents here. Supporting documents must be legible. Photos or scanned copies are acceptable as long as all of the information that is on the hard copy is available on the digital copy. If you are submitting a document that has information on the back as well (such as a bill with terms and conditions on the back), then please submit both sides.

Drop files here or

Max. file size: 512 MB.

KITESTRING

OZARK ORTHOPEDICS

CRIBB INSURANCE

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