Reimbursement Information

Purdue ASME Reimbursement Information
Name*
ASME Membership Number*
Check Delivery*

Hold for PickupDeliver to address below
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
Phone Number*

Area CodePhone Number
Activity Name*
Activity Date*

MonthDayYear
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

Upload a File

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

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

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Purdue ASME Reimbursement Information