WUSPBA Purchase & Reimbursement Request Form

Purchase & Reimbursement Request Form

Please use the following form to submit a request for purchase/reimbursement.

* indicates required field


Itemized Requests

You may add up to 4 itemized items. No item shall exceed $999.99. If you require more than 4, or have a request which is larger than $999.99 please contact the WUSPBA treasurer directly. If you have difficulty with this form, please contact the WUSPBA treasurer directly.





Enter payment receiver information (i.e. John Doe, 123 anywhere St, Someplace, PA 18801)


Acceptable file types: doc,docx,pdf,txt,gif,jpg,jpeg,png.
Maximum file size: 5mb.
You may attach scanned documents to support your claim for reimbursement.