Request Reimbursement | Legacy Global

Subject *

Fund Name *

Your Name *

Your Email *

Amount *

Recipient Name *

Recipient TIN *

Description

How does this fulfill the charitable mission? *

Explain how this payment directly advances our mission. Be specific about the need being met.

Who are we helping, and how do we know they qualify? *

Name the individual, family, or group. If the payee is an organization, describe the people it serves. Note what supports the need (application, invoice, referral, etc.).

Does anyone other than the person(s) we are helping benefit from this payment? *

Yes

No

If YES, is it a necessary and relatively insubstantial byproduct? Please Explain. *

A byproduct is acceptable if it’s unavoidable in delivering the help and small compared to the benefit to the people we serve. Example: paying a landlord benefits the landlord, but that’s necessary to house the client.

Does the payee or anyone benefiting have a relationship to the charity? *

Yes

No

If YES, please explain. *

Officers, directors, staff, donors, or their family members or businesses.

Attachment *

Attach Reimbursement request and supporting receipts here.

Request Type

Expense Reimbursement

Thank You For Your Request