Reimbursement Request From

Date*

Name of Association/Property*

This is the name of the community you are requesting reimbursement from.

Name of Person Requesting Reimbursement*

First Last

Address*

This will be the address of the person requesting the reimbursement, this will also be where the reimbursement check will be mailed.

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone*

Email*

Description of purchase:*

Please give a full description of what you are requesting reimbursement for, include the reason of purchase and if this was approved by the board of directors or a social committee.

Amount of Requested Reimbursement*

This is the amount of reimbursement you are requesting, Please note this amount must match the total in the receipts you will be attaching to this form as proof of payment.

Receipts*

Please upload receipts for proof of payment/purchase (MUST BE A PDF)

Accepted file types: pdf, Max. file size: 150 MB.

Receipts

Please upload receipts for proof of payment/purchase (MUST BE A PDF)

Accepted file types: pdf, Max. file size: 150 MB.

Signature*

By signing here you agree to the terms and conditions of the Blackstone management reimbursement policy and guarantee under penalty of perjury that the receipts submitted have been duly used by the Association or project listed on this form.

Reimbursement

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