Page 319 - Onboarding May 2017

Board of Director 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

Board Member Name
Company Name Send completed form to:
Address Susie LaBeth
City, State, Zip 8140 Ward Parkway
Email Address Kansas City, MO 64114
Phone Number 913.890.0102
Board Meeting Date susie.labeth@cscscoop.com

Make Check Payable To

The maximum reimbursement per Board meeting is $1,000. Please attach copies of receipts.
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.

Board Member Signature

Date

CSCS USE ONLY
Signature

Name
Title
Date

Invoice #