Affidavit of No Receipt

Please fill out the form below for review of reimbursement. This form is required if you are seeing reimbursement and:

  • You lost or misplaced your receipt
  • Your receipt was destroyed or unreadable
  • You did not obtain a receipt
  • The receipt submitted for reimbursement was not itemized

Once submitted, please allow 14-21 business days for process and decision. If approved, reimbursement will be mailed to the address submitted with the original reimbursement form.

FINANCE: Affidavit of No Receipt
Total amount combined of missing receipts/receipts with inadequate information