Reimbursement Request

Use this form to submit reimbursement requests.

Name

Provide the name of the individual who is requesting to be reimbursed.

First Name

Last Name

Address

Provide the address where the check should be sent.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Budget for Reimbursement

Which budget should be used for this reimbursement?

Purpose of Reimbursement

Explain the purpose of the purchase.

Total Reimbursement Requested

Provide the amount to be reimbursed.

Digital Signature

Provide your name affirming that this purchase was necessary for The Arc of Bartholomew County's mission.

To finalize your request, please email all relevant receipts to info@thearcbc.org.

Mailing Address

2060 Doctors Park Dr, Columbus, IN 47203

Email
info@thearcbc.org

Phone Number
812.372.0610

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The Arc of Bartholomew County is a 501(C) 3 Nonprofit Organization in the United States.