HomeMy WebLinkAboutREIMBURSEMENT FORM - 19-00473 - Walmart - MechanicalReimbursement/Claim Form
Use this form for reimbursement or for an invoice that does not need a purchase order.
E-mail
Name *
Phone Number *
Street Address
City State Zip Code
Department*Department No
Date Incurred*Description*Amount*GL Expense Code *Acct Description Receipts/W9
Total Reimbursement Requested
Signature
Date
Payee Information
lindsayp@mechmasters.com
Mech-Masters, Inc
208-463-7550
Address
10850 Ustick Rd
Nampa ID 83687
Expenses
If expense needs to be applied to more than 1 GL account, Add additional rows for disbursement.
Building Safety 424
08/20/2019 refunding mechanical a
duplicated permit
258.66$2832212 PERMIT- MECHANICAL CITY
OF
REXB…
W9.p…
56…
REC…
- 19-
00473
-
Walm…
-
Mech…
41…
258.66$
09/26/2019