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PAYABLE TO (FULL NAME):

EMPLOYEE #:

SCHOOL :

DEPT./ PURPOSE:

DATE:

SUPPLIER

RECEIPT

DATE

ACCOUNT NO. GST PST

RECEIPT

AMOUNT

TOTALS:

NOTES:

STAFF SIGNATURE:

AUTHORIZATION SIGNATURE:

Revised 01/17/14

STAFF REIMBURSEMENT FORM

I certify that the above expenses were paid by me in the course of my work for the Chilliwack School District during the

indicated period.

In the business world, everyone is paid in two coins: cash and experience. Take the experience first; the cash will come later. | Harold Geneen