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 by email - click here (you may also drop it off at the office, or mail it to 3001 Riverside Park Drive, Vero Beach, FL 32963) Form fields with an “ * ” are required to be filled out to submit the form. Please fill out any additional fields as needed (date required if you have a deadline to receive the check, no invoice or receipt available, etc.).

Name *
Name
Fill out the company or name of the person who will be paid.
Deliver by *
Please choose one option
Please type in complete mailing address including any Suite or Apartment number, City, State and Zip Code if you requested that your check be mailed.
Enter the exact amount of the reimbursement request
$
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 *
Please select the event or choose "Other" if not for a specific 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: click to email (you may also drop it off at the office, or mail it to 3001 Riverside Park Drive, Vero Beach, FL 32963)