BHBL ROTARY

Request for Funds 

Submit to Treasurer following Board (2 member) Approval

Date:  ___/____/______

Requestor: ________________________________________

Committee: ________________________________________

Chair Person: ________________________________________

Check to be made out to: ________________________________________________________

                                            ________________________________________________________

Send to Address:                   

        ______________________________________________________

                                            ________________________________________________________

Amount: $______________________________

Check Due Date:  ___/____/______

Explanation for expense:

Receipt total:

Non-receipt total:

Explanation for lack of receipts:

Required Board Member (2) Approval:

Print Name                                         Signature                                   Date

1_______________________________       _________________________    ___/____/______

2_______________________________       _________________________    ___/____/______

Attach receipts: