Reimbursables Request Template

Title: YYMMDD - [Item Paid for] Reimbursable Request


Name of Service or Payment to be reimbursed for

Time period for the service that was paid for (if applicable)

Backup

receipt of payment, transaction hash, or other information necessary to show that payment was made.

Amount Owed

Sum of re-imbursable amounts and desired compensation method/currency.

Repayment Wallet

Add Ethereum wallet where you want to be reimbursed.

Notes

Any other pertinent information