Information about the person requesting reimbursement
Number / Street Name
CAREFULLY enter the email address where you would like us to send payment. Please understand that if you enter the wrong email address on this form, your payment may be permanently lost.
Example: [email protected]
Information about expense approval
First and Last Name of NHHA Executive member
Enter Information about the expense. NOTE: You may submit only ONE expense per form. If you have multiple expenses, you must submit them individually.
e.g. Describe the product/service purchased and what it was for
Total amount of expense being submitted for reimbursement
Date when purchase was made/paid.
Receipt and Pre- Authorized Banking Attachments
Allowed extensions: .jpeg, .jpg, .png, gif, .pdf, .doc, .docx.Maximum # Files: 2. Maximum File Size: 4MB.
Allowed extensions: .jpeg, .jpg, .png, gif, .pdf, .doc, .docx.Maximum # Files: 5. Maximum File Size: 4MB.