Reimbursements Form **Reimbursements must be submitted within 60 days of purchase.** Name(Required) First Last Email(Required) Are you requesting a reimbursement or would you like to donate the money spent directly to Labeled & Loved?(Required) Reimbursement Donation to L&L - please send me a tax receipt Program you are requesting reimbursement from:(Required) Retreat Sisterhood Circles Fundraising Moms Events Other Program NameWould you like to receive your reimbursement via Zelle or Check?(Required) Zelle Check Reimbursement Receipt What is the phone number or email linked to your Zelle account?What address would you like the reimbursement check mailed to? Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands *Please note that this will come in a white envelope from Bank of America, not from Labeled & Loved.This field is hidden when viewing the formLabeled & Loved is a 501c3 non-profit organization that is exempt from sales tax in Texas, Colorado, Oklahoma, and Tennessee. We can not reimburse sales tax in exempt states. I did present the tax exemption form on the purchases that qualified as tax free. I did not present the tax exemption form, and I understand the taxed amount will be deducted from my reimbursement request. Labeled & Loved is a 501c3 non-profit organization that is exempt from sales tax in Texas, Colorado, Oklahoma, and Tennessee. We can not reimburse sales tax in exempt states.(Required) I understand that I will not be reimbursed for taxes. Please upload a copy/picture of the original receipt(s) here:(Required) Drop files here or Select files Max. file size: 512 MB, Max. files: 25. Please list vendor and amount below of the receipt(s) you have attached. If including multiple receipts please list individual vendors and amounts below. Description Cost $ Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. TotalI attest that this reimbursement request is accurate and these purchases were made for Labeled & Loved programming. This is considered an electronic signature. Please type your full name.(Required)CAPTCHA
