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Expense Reimbursement Form





         The expenses on this form relate to the following Board:
                 CSCS Joint Board        Apple Supply Chain Co-op Board    Pancake Supply Chain Co-op Board

                                                                                  Other

         Name
         Company Name                                                                     Send completed form to:
         Address                                                                                  Amanda Trosen
         City, State, Zip                                                                      8140 Ward Parkway
         Email Address                                                                      Kansas City, MO 64114
         Phone Number                                                                              913.890.0122
         Meeting Date                                                               amanda.trosen@cscscoop.com


         Make Check Payable To




           Date Incurred                Purpose / Explanation                    Merchant            Amount






















                                                                                                  $                    -
         I certify that the expenses for which I am seeking reimbursement are in accordance with the Board's travel policy.

                        Signature

                            Date



         CSCS USE ONLY
               Signature

                  Name    Dustin Pittman
                   Title    Chief Financial Officer
                   Date

                Invoice #
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