AIA East Tennessee Request for Reimbursement Form

Thank you for purchasing something for AIA ETN. Now, let’s get you reimbursed! Reimbursement requests must be received within ninety (90) days of the expense. If you have any questions about eligible reimbursement expenses or issues with this form, please email Dustin at dustin@aiaetn.org.

Name(Required)

First Last

Email(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Date the purchase was made(Required)

What program or committee did you make a purchase for?(Required)

Please select which committee you have made your purchase for. Please select only one committee per form. If you have multiple receipts, please fill out a request for reimbursement form for each receipt.

Purchase Explaination(Required)

Please provide a brief explanation of each expense you are submitting for reimbursement.

Receipt(Required)

Please upload the receipt that you are requesting reimbursement for.

Max. file size: 500 MB.

Reimbursement Request Total

Please put the total amount of funds you are requesting to be reimbursed for below.

Where would you like us to send your check?(Required)

Mail to Address Listed Above

Mail to Place of Employment

Hand-Deliver (If located in Knoxville)

Place of Employment Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Where would you like to meet?

Jen will reachout to coordinate time/date for delivery.

AIA East Tennessee Request for Reimbursement Form

AIA East Tennessee Request for Reimbursement Form

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