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: 2 MB.

Receipts

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

Accepted file types: pdf, Max. file size: 2 MB.

How do you want to get paid?*

Please let us know how you would like to get your reimbursement funds. Select from the options below.

Check Terms*

Please note that when requesting a check for reimbursement this may take up to 30 days depending upon the United States Postal Service. We have no control over the postal process, it may take two to three business days to process your reimbursement at our office however once placed in the mail we cannot guarantee the delivery time frame.

I Agree and want to be mailed a check

Name of Bank*

Type of Account*

Bank Routing Number

Bank Account Number*

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.

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