Reimbursement Form | The Pink Agenda

Issue Check To*

Address*

City, State Zip Code*

Phone Number*

Email address*

Event to Charge*

Date of Expense*

Description of Expense*

Amount*

Upload Receipts (Attach all receipts and pre-approvals to this form for prompt reimbursement)*

Signature (By signing this document electronically, you agree your electronic signature is the
legal equivalent of your manual signature on this document.)*

Reimbursement will not be made without an itemized receipt and any associated back-up (emails, letters, contracts, etc.)

All reimbursements must be submitted no later than 30 days after an event
Be sure to use the tax-exempt form.

TFor any questions, please reach out to finance@thepinkagenda.org.