Reimbursement Information

Name *

ASME Membership Number *

Check Delivery *

Hold for Pickup Deliver to address below

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

E-mail *

Phone Number *

Area Code Phone Number

Activity Name *

Activity Date *

Month Day Year Date Picker Icon

Transaction Amount *

Please upload your itemized receipt. Some items to consider:

1) You cannot be reimbursed for alcohol, tobocco, or related expenses. If any of these items are on your receipt, black out those items and adjust the total price (including tax) to reflect this change.

2) Tips may only be reimbursed up to 20%.

3) The credit card signature receipt shows method of payment and is not acceptable documentation to process a reimbursement alone. The credit card signature receipt may show the tip given, but the detailed receipt or invoice is also required as proof of items purchased for reimbursement.

4) Items displaying any Purdue University trademarks must come from licensed vendors. A full list may be found here.

Accepted formats: .jpg, .pdf

Receipt

If your anticipated reimbursement is over $75.00, sign this form and upload here as a .jpg or .pdf.

Reimbursement Certification

If you have lost your original receipt, fill out the Lost Receipt Affidavit and upload here as a .jpg or .pdf.

Lost Receipt Affidavit

Purdue ASME Reimbursement Information