LTYA Reimbursement Request

Lake Travis Youth Association Reimbursement Request

Please complete this form to request expense reimbursement from the Lake Travis Youth Association. Please note that no reimbursement can be processed without a valid receipt. You may electronically submit this form along with an scanned copy of your receipt. Otherwise, you must PRINT the completed form and MAIL it, along with RECEIPTS, to the address below. LTYA is not able to reimburse for sales tax.

Please note: You must click on SUBMIT at the bottom of this form.

First Name *

Last Name *

Address 1 *

Address 2

City *

State *

Postal Code *

Daytime phone

Evening phone

Email Address

Please select the appropriate sport/class for this expense: *

Please select the appropriate category for this expense: *

Description of expense: *

Reimbursement amount (do not include sales tax): *

You may use this space to attach an electronic copy of your receipt:

If you are unable to attach an electronic copy of your receipt,
please PRINT this form, attach receipts, and MAIL to the following address:
LTYA
2101 Lakeway Blvd.
Suite #115
AUSTIN, TX 78734
Please be aware that NO reimbursement can be processed without a valid receipt to accompany the request.

Additional instructions/Comments:

TREASURER USE ONLY:

Date approved:

Date mailed:

Check number: