SMSA Reimbursement Forms

Instructions

The following documents are required for reimbursement:

For in-person purchases:

Store Receipt that was printed for you at the time of purchase. If the receipt is not to be fully reimbursed please highlight reimbursable items.

For internet purchases OR purchases that gave you a plain-paper receipt:

Copy of the invoice/ registration/ flight purchase confirmation/ hotel receipt
Bank account or Credit account Activity showing Purchase and last 4 digits of account (example)
To associate your name with the purchase, we require EITHER:
Scanned Debit / Credit card with all but name and last 4 digits blacked out (example)
OR
Bank or Credit Accounts Overview with all sensitive info blacked out except Full name and last 4 digits of account (example)