Reimbursement Form

Reimbursement Request Form

Request reimbursement for approved District 5330 expenses.

DOWNLOAD THE FORM

Get started

District officers, committee chairs and event chairs can request reimbursement for approved District expenses. Download the form below, fill it in, attach copies of your receipts or invoices, and send the whole thing to the District Treasurer as one combined PDF.

Download the Reimbursement Request Form (PDF, 51 KB)

The form is a fillable PDF — open it in any PDF reader, type straight into the fields and save it. You can also print it and complete it by hand.

WHAT YOU’LL NEED

Completing the form

  1. Member information. Your name, email, phone, mailing address, club name and the date. Payment goes to the person named as the requestor, so make sure the mailing address is the one a check should go to.
  2. Event chair signature. The event chair signs and dates the form.
  3. Expense details. Itemize each expense by date, description, amount and DG expense year, then enter the total.
  4. Receipts. Attach copies of your receipts or invoices as supporting documentation and submit everything as one combined PDF.
  5. Event affiliation. Tick at least one — District Training Assembly, District Conference, Foundation Dinner/Gala, Rotary Leadership Institute, Pre-PELS, PELS, PRYDE, RYLA, RYE, Music Competition, Four-Way Speech Competition, Presidents Advance, Zone Institute (GNLS, GELS or ERL), RI Convention, or Other.
  6. Payment method. Tick either Bill.com or Check (see below).

Reimbursements must fall within the approved District budget.

PAYMENT METHOD

Choose how you’d like to be paid

Bill.com — preferred

Bill.com is the District’s preferred method for reimbursements. Once your request is received, the Treasurer sends an invitation link to the email address on your form — use that secure link to sign up for ACH payments straight to your bank account.

Check

If you prefer to be paid by check, tick the Check box and a check will be mailed to the mailing address you provide on the form.

WHERE TO SEND IT

Submit to the District Treasurer

Mail, fax or email your completed request to the District Treasurer.

Mail

Allyson J Trantum, CFP
District Treasurer
27710 Jefferson Ave, Suite 104
Temecula, CA 92590

Phone & fax

Phone: (951) 440-7917
Fax: (951) 473-2234

You can also reach the Treasurer through the District Leadership page.

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