Jimmy Blankenship and
Joyce Talley (540)967-1364
Treasurers
Check/Reimbursement Request
Date _____________
Make check payable to:
____________________________________________________
Deliver check to: (address)____________________________________________
____________________________________________
Amount of expenditure $______________
Reason:
________________________________________________________________
Request presented by:
____________________________________________________
Phone: (Home)___________________ (Work)___________________
Budget Account to be
charged: _____________________________________________