Request a Reimbursement

Please fill out the form below to request an expense reimbursement.

NOTE: The IRS only accepts ORIGINAL receipts and invoices, not scans or copies. If you have physical receipts or invoices to submit, please fill out this form and mail it along with your receipts/invoices to:

Anne Lynne Charbonnet, NOTG Treasurer
8141 Maple Street
New Orleans, LA 70118

Total Amount of Payment Requested *

Make Check Payable to *

Deliver or Mail to *

NOTG Member
Third Party

Recipient Name *

Recipient Address *

Address Line 1

Address Line 2

City

State

Zip Code

Area of Expense *

Community
Fundraiser
Administration
Other

If Other, Specify Area of Expense

Expense Description *

Upload original invoices and/or receipts for reimbursement (IRS does not accept copies). *

Click or drag files to this area to upload. You can upload up to 10 files.

Memorial Donations

In Memory of

Acknowledgements

List as you want the person addressed along with their mailing address.

Name

If you wish to mail in your request, please download and fill out this form. Mail the completed form along with your ORIGINAL receipts/invoices to:

Anne Lynne Charbonnet, NOTG Treasurer
8141 Maple Street
New Orleans, LA 70118