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2023 EBLAX CHECK / REIMBURSEMENT REQUEST
Please e-mail your documentation to:
hillier7@sbcglobal.net
or mail to: Attn: Derek Hillier, East Bay Lacrosse, 18 Maple Ave, PMB 268, Barrington, RI 02806
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Email
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PAYEE INFORMATION
Enter the name and address of the person requesting this check:
Your Name
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Your answer
CONTACT INFO
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Enter your email address and/or cell phone #.
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PAYEE
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Your answer
ADDRESS (Be sure to include, Street, City, State AND ZIP) or it won't be processed.
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CHECK REQUEST DETAILS
AMOUNT
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Your answer
REASON
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Ex. USA Lacrosse membership, etc.
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Additional comments?
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Expense Documentation (invoice or receipts)
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You must submit your documentation before a check will be issued to
hillier7@sbcglobal.net
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