Lone Star Model A Ford Club

Date	Vendor	Description	Amount

Remit to Payee (One Payee per form)            Name Address City,TX,Zip

Requestor's Name: Signature: Phone: Email: Date:

Receipts / Invoice Enclosed Yes NO

Comments:

Reviewed and Approved by

President:   Signature: ___________________________

or For the President's purchases

Date:
Check Number
Comments:

Treasurer:
Signature:	________________________________
Date:

To get reimbursed, fill out the form, print it, sign it, and scan or mail it to the president.

You can also request a Word document where you can fill in the form.