Region(Required) Dist 01 Dist 02 Dist 03 Dist 04 Dist 05 Dist 06 Dist 07 Dist 08 Dist 09 Dist 10 Dist 11 Dist 12 Sect 01 Sect 02 Sect 03 Sect 04 Sect 05 Date(Required) MM slash DD slash YYYY Transaction Type(Required) Revenue Expenditure Category(Required) Speech Theatre Middle Level Debate Administrative Expenditure InformationExpenditure Type(Required) Contractor Mileage Expense Select all that apply.Payable Entity/Contractor(Required) This form can only be completed once per person/entity to whom reimbursement is being made. Complete the form separately for separate entities.Email(Required) 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.Contractor phone(Required)So we can contact contractor with questionsHonorarium description(Required) Brief description of services rendered by contractor.Contractor Honorarium(Required)Please enter a number greater than or equal to 0.01.Expense description(Required) Expense(s) to be reimbursed.General Expense Amount(Required)Please enter a number greater than or equal to 0.01.Starting Address(Required) Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code 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.Roundtrip Mileage(Required)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.RateWHSFA approved mileage reimbursement rateMileage AmountReceipt(s) Drop files here or Select files Accepted file types: jpg, gif, png, pdf, doc, docx, Max. file size: 128 MB. Expenditure TotalRevenue InformationPaid by(Required) Name(s)/entity(ies) payment received on behalfBrief description(Required) What payment is forPayment Amount(Required)Please enter a number greater than or equal to 0.01.NotesInvoice Open Paid Vendor Contract Check Issued MM slash DD slash YYYY Check No. Δ
