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Expense Reimbursement Form

Use this form to request reimbursement under the Guild's Accountable Plan. Submit within 60 days of incurring the expense. Claims older than 120 days are denied without a written exception.

Claimant information

  • Name:
  • Role with the Guild (board / officer / committee / staff / volunteer / member):
  • Email:
  • Phone (optional):
  • Mailing address:
  • Payment method: ☐ ACH (preferred — attach voided check or routing letter) ☐ Paper check
  • Date of this submission:

Expense detail

Add one row per receipt. Duplicate the block as needed.

Expense 1

  • Date incurred:
  • Vendor / merchant:
  • Amount: $
  • Category (fuel / parking / tolls / transit / lodging / meals-travel / supplies / printing / postage / software / background check / training / other):
  • Business purpose (one sentence — what, why, who benefited, which Guild activity):
  • Pre-approved by (name + date, if amount > $250 or required by policy):
  • Receipt attached? ☐ Yes (itemized) ☐ No — explain:

Expense 2

  • Date incurred:
  • Vendor / merchant:
  • Amount: $
  • Category:
  • Business purpose:
  • Pre-approved by:
  • Receipt attached? ☐ Yes ☐ No — explain:

Expense 3

  • Date incurred:
  • Vendor / merchant:
  • Amount: $
  • Category:
  • Business purpose:
  • Pre-approved by:
  • Receipt attached? ☐ Yes ☐ No — explain:

Mileage / vehicle (Guild reimburses actual fuel + parking only — no per-mile rate)

  • Trip date(s):
  • Origin → destination:
  • Guild purpose:
  • Fuel receipt attached? ☐ Yes ☐ N/A
  • Parking receipt attached? ☐ Yes ☐ N/A
  • Toll receipt attached? ☐ Yes ☐ N/A

Advance reconciliation (if this submission settles a previously issued advance)

  • Advance amount received: $
  • Date advance issued:
  • Total expenses substantiated above: $
  • Excess to be returned to the Guild: $ (returned by ACH/check on date: _______)
  • Or shortfall owed to the claimant: $

Claimant attestation

I certify that: - Each expense above was incurred in the performance of Guild business. - Every receipt and amount is true and accurate. - No expense above has been or will be reimbursed by any other source. - I understand that reimbursements paid under the Guild's Accountable Plan are not income, are not reportable on a W-2 or 1099, and are not earnings for SSA purposes — provided every requirement of the policy is met. - I understand the Guild does not forgive expenses in lieu of reimbursement and does not issue compensation in any form (memberships, stipends, fee waivers) in exchange for volunteer service.

Claimant signature: ____________________________ Date: __________

Approval (Treasurer / Administrator / Board Chair as required by policy §5)

  • First approver name + role:
  • First approver signature + date:
  • Final approver name + role (if claim > $250 or claimant is the Administrator/Treasurer/Board member):
  • Final approver signature + date:
  • Total approved for payment: $
  • Notes / exceptions:

Bookkeeper use only

  • QBO transaction ID:
  • Expense category coded to:
  • Vendor record (must be type "Reimbursable — not 1099"):
  • Payment date:
  • Payment method + reference (ACH trace # / check #):
  • Filed at: Finance/Reimbursements/<year>/<month>/<lastname-first-initial>/