This area for office use only:
Account:_________    Date Ent:_________        Bill Pay ___
Check #: ________   Credit Card__   Debit Card __  EFT ___

Arisia, Inc. Expenditure form (Rev 11/16)	   
Read the entire form before filling in any part.
Purchases made for Arisia, Inc. are not subject to Mass sales tax. Mass State Sales Tax Exemption Number: 04-031143

Today’s Date:__________  Expense Date: _________  Your Name: _______________________________ 
Why are you filling out this form (check one): request a check__, authorize payment of an invoice (bill)__, clear a cash advance (individual):__, clear a cash deposit (vendor):__, other (specify): _______________ 
Is this a Corporate ___ or a Convention ___ outlay? Check here if for item used more than one year:___ 
How does this affect the books: Expense___, Cash Advance___, Security Deposit (refundable) ___,              Cash Deposit in advance of actual expense___, Other (specify): ____________________________ 
If this is a deposit, when will the funds be returned or applied to a bill?____________________________ 
Disbursement authority (check one):   Convention Budget___, Corporate Budget___, Corporate Vote___, Eboard Vote___, Officer Discretionary Authority___, Fund ________________

Person to be paid: Purchaser__,  Vendor__.  Vendor/Payee Invoice/Account #:_______________________ 
Recipient Name:___________________________________________ Phone #:______________________ Address:	_____________________________________________________________________________
		_____________________________________________________________________________
City 	___________________________________________________State______ Zip_____________

Detailed List of Expenses: 
Vendor or Source	Item	Dept/Account	Qty.	Cost	

					

Check here if continued on back __ 	 Total Cost: $____________ 
If payment is to the purchaser, receipt(s) must be included with this form. If payment is to a vendor, an invoice must be attached. If receipts cannot be supplied, a memo detailing the reason must be approved by the corporate treasurer. 
Approval (Dept Head/Convention/Corporate Officer):
 Name:____________________________________ Signature:_________________________________ Treasurer’s Approval (Signature): _______________________________________ Date: ____________ 
Nothing in this form shall be considered a guarantee of payment. The Treasurer reserves the right to refuse incorrect, incomplete or illegible forms.