Reimbursement Claim Form

Reinbursment Claim Form

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BYLAW: Failure to be game day ready.

Verifiable proof (receipts, invoices) of loss MUST be sent in to the league owner within 24 hours of the infraction

Owners Name

First Name

Last Name

Phone

Team Name

Owners Name Claim is being filed against

Date of Incident

Description Of Incident Causing Claim

Amount of reimbursement requested

Amount can not exceed $500.00 and receipts must be provided to file this claim

Proof of financial loss

Signature

By signing this claim I am verifying that my statements made and loss taken are true and verifiable. I do understand the league will NOT make calls or contact parties to collect proof on my organizations behalf. I am responsible for providing my own evidence. The league will however investigate my claims to ensure validity once all my proof has been provided.

Full Name

Sign

Payment

Discount

Subtotal

Tax

Total USD

Reimbursement Claim Form

Payment

The form has been submitted.