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Reimbursement Form

Please use this form to submit reimbursement requests to the WEMTA Treasurer.
If you need to send receipts or vouchers via snail mail, please use the following address:
Kathy Sanders.
If you have receipts, please scan them and send them to Kathy Sanders via email, as an attachment.

WEMTA Reimbursement Form:

1.
*

First Name:
2.
*

Last Name:
3.
*

Street Address:
4.
*

City:
5.
*

State:
6.
*

Zip:
7.
*

WEMTA Account:
8.

Mileage: Total miles x .40 cents per mile=
9.

Drove from where to where?
10.

Amount of Expense:
11.

Description of Expense:
12.

Receipt will be coming via (*not necessary for mileage reimbursement):
eMail attachment   Snail Mail   FAX to WEMTA

* Enter Your Email Address:

Type in the text that you see above: