Request for Advertisement Reimbursement 4254 Saw Mill Run Blvd., Pittsburgh, PA 15227
District Information
Advertising Information
District Number City/State Type of Advertising
Date Published or Submitted (Purchased): Itemize expenses and attach copies of receipts to this form All receipts and copies of canceled checks must be attached to this form along with an itemization of expenses. If receipts are unavailable, give detailed explanation for expense below. Failure to comply with this request may result in refusal of request for Advertising Reimbursement.
TOTAL COST TO DISTRICT
$
Send the Home Office the original or a copy of the ad. If it is not an advertisement in a paper, please send a picture.
Authorization
Signature of President
Date:
Signature of Secretary/Treasurer
Date:
Prepare an original and copy, retaining copy for district records, mail the original to the GBU Community Engagement Team.
Home Office Use Only
The above request for Advertising Reimbursement has been: Approved
Denied
If denied, provide reason:
Phone: 412-884-5100 | 800-765-4428 | memberbenefits@gbu.org | gbu.org AD_REIMBURSE-1123_5
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