Electronic Reimbursement/Check Request Form

PLEASE NOTE ONLY COMMITTEE CHAIRS MAY SUBMIT THIS FORM FOR REIMBURSEMENT/PAYMENT. Fill out and submit the form below to submit a request for payment to a vendor, reimbursement to a committee member or other authorized request for payment. Please email any receipts, invoices or other documentation to
info@verobeachartclub.org (you may also drop it off at the office, or mail it to 3001 Riverside Park Drive, Vero Beach, FL 32963)

Name *
Name
Fill out the company or name of the person who will be paid.
Deliver by: *
Please type in complete mailing address including any Suite or Apartment number, city, state and Zip Code
$
Date needed by (if needed by certain date ) :
Date needed by (if needed by certain date ) :
If you don't need the check issued by a certain date, disregard.
Event *
I, the requestor for the Reimbursement/Check Request, warrant the truthfulness of the information provided in this form. Please type your first and last name in this box.
Agreement to Terms of Acceptance *

Once you have submitted this form, please email any receipts, invoices or other documentation regarding the request to: info@verobeachartclub.org (you may also drop it off at the office, or mail it to 3001 Riverside Park Drive, Vero Beach, FL 32963)