Reimbursement Form

Thank you for filling out as much information as possible for the reimbursement form. Please expect between 1-2 weeks for a repayment. If you have any questions, please contact Gail at grees@nbtbank.com.

Date *

Person/committee requesting: *

First

Last

Email *

Amount requested *

Which budget should this come from? *Choose one* *

How do you want to be repaid? Pick one. *

If you picked Venmo or Paypal, what is your handle? Ex. @supportersofca or @emily-loder

If you picked check, who should it be made payable to?

Reason for request - be sure your receipts (or description) include dates *

Please upload any receipts or relevant documents *

Click or drag files to this area to upload. You can upload up to 10 files.

Any other information we should know?

Reimbursement Form

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