DISTRICT 5180 REIMBURSEMENT/APPROVAL REQUEST
Payee: (person to be paid)
Address to mail check
Activity or Event
Invoice: (attach original receipts)
Amount: $
Charge to: (as shown on District Budget)
Name
Approved by
(For District Use) Check No.
(For District Use) Amount
(For District Use) Date
Rotary District E-Form T100 Rev 1