The Embroiderers' Guild of America, Inc.
Request for Reimbursement/Payment

Complete this form, then print and send for payment.
Enter Today's date of ... :    -- mm/dd/yy  
Submitted By:     Office or Committee:
PAYEE: 
                Name
              
                Street Address
                   
                City                                                            State           Zip

Expenses Category Amount Requested

Receipts Attached
yes/no

 Budgeted Item
yes/no

Treasurer's Use
Account
Telephone____________
Postage____________
Printing/Copying____________
Supplies____________
Teaching Fees
Attach Contract		____________
Kit fees____________
Travel____________
Lodging____________
Per diem____________
Other
(itemize below)		____________
____________
____________
____________
____________
____________
Total____________
  -  This form must be used for all reimbursement/payment requests.  
  -  Receipts must be attached with SR-EGA expenses marked.  
  -  A postage receipt or log of all correspondence is acceptable.  
  -  Any non-budgeted items or items over the budgeted amount must be approved in advance by the Sun Region Board.   
  -  Send form with attached receipts to:    Pam Burke,   Sun Region Treasurer
                                                                          118 Dana Pointe,
                                                                          Niceville, FL   32578
For Treasurer's use only
Receipts attached: ______________
Approved: ___________________		 Date received:________________
Math checked: ________________
Posted: ______________________		 Date paid: ____________________
Check #: _____________________
Amount: ______________________

Revised: Mar. 13, 2006
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