District-Section Financial Transaction Form

Region(Required)

Date(Required)

Transaction Type(Required)

Revenue

Expenditure

Category(Required)

Expenditure Information

Expenditure 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 questions

Honorarium 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 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.

Rate

2024 IRS mileage rate

Mileage Amount

Receipt(s)

Drop files here or

Accepted file types: jpg, gif, png, pdf, doc, docx, Max. file size: 128 MB.

Expenditure Total

Revenue Information

Paid by(Required)

Name(s)/entity(ies) payment received on behalf

Brief description(Required)

What payment is for

Payment Amount(Required)

Please enter a number greater than or equal to 0.01.

Notes

Invoice

Open

Paid

Vendor

Contract

Check Issued

Check No.