Northwest Region

Wound Ostomy and Continence Nurses Society

Expense Voucher

Name:____________________________________Date_______________

Address:_____________________________________________________

City:________________________ State:_____________ Zip:__________

Phone: (work) ___________________ (home) _______________________

Purpose: _____________________________________________________

Items for Reimbursement                     Explanation                                    $ Amount

                                                                             Total________________

Guidelines for Reimbursement:

1. Paid receipts must accompany the voucher when submitted.

2. Expense voucher must be completed and submitted after expenses are incurred.

3. All vouchers must be submitted to the Treasurer within 60 days after expenses are incurred.

4. Reimbursement will be made according to the budget or per a decision of the Budget and Finance committee.

5. Keep a duplicate copy of your voucher and receipts for you personal records.

Office Use:

Date paid: ___________  Amount Paid: __________  Check # _____________________

Treasurer Signature______________________________