Expense Reimbursement Form - Legacy at Jordan Lake

Expense Reimbursement/Invoice Submittal Form

Legacy at Jordan Lake
All invoices and reimbursement requests require a detailed invoice/receipt before approval.

If you cannot attach the invoice/receipt to this form,

please mail to PO Box 1149, Apex NC 27502.

Please have reimburseable items on a separate receipt from any personal items.

If unavailable, please circle the items clearly.
Are you submitting an invoice or a reimbursement request?
Event / Project Name
Invoice Category
Due date of Invoice

MonthDayYear
Date
Date of Event / Project

MonthDayYear
Expense Amount
Vendor Name
Your Name
Mailing Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Submitters Email
example@example.com
Upload Receipts Here

Cancelof
Additional Notes/Comments:
Approved for Payment?
Should be Empty: