Bird Rock Foundation Payment Request 2024/2025

Complete this form to request a reimbursement check or to issue payment for a Bird Rock Foundation purchase. Checks will be available for pick up in the Treasurer outbox.

Full Name

Email Address

Your Phone Number

Please describe what was purchased.

Total Dollar Amount

Please attach any receipts related to this purchase or documentation of expense approval (if necessary).

** You agree that the purchase was made on behalf of the Bird Rock Foundation and have attached supporting documentation for this purchase or payment request. Please issue a reimbursement check for the attached receipt(s).

Select the type of payment desired:

Make check payable to:

Address of Payee (if applicable).

Cost Category

Expense amount was included in the approved budget and is authorized for payment?

yes no

Please include any additional information that may be helpful.