IMPS: FORM FOR PERSONAL REIMBURSEMENTS

Note: This form can only be filled in by an IMPS Volunteer. If you are not an IMPS Volunteer and you have picked up a dog, please call the IMPS Hotline at 1-877-Minpin1, or contact an IMPS Regional Coordinator nearest to you.
 
 
DOG'S NAME:    IMPS TAG NUMBER:    
AMOUNT TO BE
REIMBURSED:

NOTE: copies of vet/shelter bills MUST accompany this form.
VOLUNTEER's
NAME:
ADDRESS:
Email address:

 

Scan this completed form and invoice(s) into .pdf format, send to your RC for approval and send to impsreimb@gmail.com for processing.

Reimbursements over $400 must be pre-approved. This form must be submitted within 30 days of the treatment or expense. If US mail is your only option, please email impsreimb@gmail.com for instructions.