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District-Section Financial Transaction Form

Region(Required)
MM slash DD slash YYYY
Transaction Type(Required)
Category(Required)

Expenditure Information

Expenditure Type(Required)
Select all that apply.
This form can only be completed once per person/entity to whom reimbursement is being made. Complete the form separately for separate entities.
Used to send invitation for contractor to register electronically, including online completion of W-9 form. Payments will not be issued until that is received.
So we can contact contractor with questions
Brief description of services rendered by contractor.
Please enter a number greater than or equal to 0.01.
Expense(s) to be reimbursed.
Please enter a number greater than or equal to 0.01.

Starting Address(Required)
Honorarium payments will be sent to the address registered with the state office by the contractor; this is simply to indicate mileage reimbursement starting/return point.
Please enter a number greater than or equal to 1.
Please be sure this is roundtrip mileage, as calculated by starting destination and WHSFA event, and multiplied by two. Stops outside the most direct route (except for construction/detours) should not be counted.
WHSFA approved mileage reimbursement rate
Drop files here or
Accepted file types: jpg, gif, png, pdf, doc, docx, Max. file size: 128 MB.

    Revenue Information

    Name(s)/entity(ies) payment received on behalf
    What payment is for
    Please enter a number greater than or equal to 0.01.

    Invoice
    MM slash DD slash YYYY

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