CAC Expense Claim Form

Use this form to submit a claim for reimbursement of previously-approved expenditures incurred on behalf of the CAC. Please note the following:
  1. You must have your receipts scanned into up to three PDF, JPG, BMP, TIF, or GIF files BEFORE submitting this form.
  2. Expenses will only be reimbursed if they were budgeted for OR approved by:
    1. the appropriate member of the Board of Directors
    2. the appropriate committee chairperson
    3. the seminar chairperson
  3. This form must be submitted prior to the end of the fiscal year (June 30th) during which the expense was incurred.
  4. If you have any questions, please contact the CAC Treasurer at treasurer@cacnews.org.

About You:

Name of Person Submitting Form:
Phone # of Person Submitting Form:
  (only one phone number)
E-Mail of Person Submitting Form:
Make Check Payable To:
Address to Mail Check:
City, State, Zip:

About The Expense(s):

Committee or Office:
If "Other" above:
  Expense #1: $
  Expense #2: $
  Expense #3: $
  Expense #4: $
TOTAL:   $
Helpful tips for travel reimbursement (2016):
  • The current IRS mileage rate is 54.0 cents per mile.
  • Airfare maximums: $300 (in state) and $500 (out of state)
  • Accommodation maximum: $150/day
  • Per Diem: $50/day for trips requiring an overnight stay
  • Amounts in excess of those stated above require prior Treasurer approval.

On the next page, please attach your scanned receipts.
You CANNOT submit this form without attaching your receipts.