Arisia, Inc

Arisia, Inc. Expenditure form (Rev 3/98)	This area for office use only:
Read the entire form before filling in any part.	Account: ______ Date Ent: ______ Check #: ______

Purchases made for Arisia, Inc. are not subject to Mass sales tax. Mass State Sales Tax Exemption Number: 043-031-143.

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 ___, Cash Deposit in

advance of actual expense ___, Corporate Grant ___, 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 ___, Officer Discretionary Authority ___

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.