CENTER GROVE ULTIMATE CLUB
www.CenterGroveUltimateClub.com

Building Ultimate Pride at Center Grove High School Since 2003

Reimbursement/Payment Request

Form may be submitted in person with hard copy, or via email to CenterGroveUltimateClub@gmail.com

Submitted By: Date:

Email:

Home Phone: Cell Phone:

If working underneath a chairperson, they approved this purchase: yes not under a chairperson

This request is for a reimbursement payment
Reimbursement/Payment should be made to:

Mailing Address:
For (Items/Service):

Associated Event:
Mail Check: Yes No
If not, give check to:

Notes/Special Instruction:

Approved by:

PLEASE ATTACH ALL RECEIPTS AND/OR INVOICE