Supply Reimbursement Request Form

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SUPPLY REIMBURSEMENT REQUEST FORM
 
                   Use this form for reimbursement of things you paid for on behalf of the University. 
This is NOT for travel or entertainment or corporate card payments.  Please use other forms for those. 
 
 
Your name:____________________________________  Today’s date:____________________________ 
 
Your email:____________________________________  Your phone#:____________________________ 
 
Your full home address:__________________________________________________________________ 
 
What did you purchase?_________________________________________________________________ 
 
Reason for purchase?___________________________________________________________________ 
 
Where did you purchase this?____________________________________________________________ 
 
Amount to be reimbursed:  $_____________________________ 
 
Name of PI authorizing this expense:_______________________________________________________ 
 
SIGNATURE of PI authorizing this expense:__________________________________________________ 
 
ACCOUNT paying for this expense: ________________________ 
 
Account manager approval*:______________________________  (*to be completed by BME A/P) 
 
 
 
***Please sign the original receipt, attach it to this form, and submit both to BME Accounts Payable.*** 
 
 
                              
 
ALL LINES ABOVE MUST BE FILLED OUT FOR REIMBURSEMENT PROCESS TO CONTINUE. 
 
Thank you! 
 
 
 
 
Out of pocket expenses cannot exceed $500 in costs, ever.   
They also should not be incurred for any item that can be purchased through the BME Purchasing 
 
Department.

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