Reimbursement Request
Your Contact Information

Name:

Email Address:

Telephone Number:

Reimbursement Request

First & Last Name

Complete Mailing Address: Street Address, City, State & Zipcode

Did you make a purchase? Did you transport the Reins of Hope trailer? Did you volunteer the use of your horse for Sessions? Did you transport horses for use during a Reins of Hope Session?

I made a purchase
I transported the Reins of Hope Trailer
I made a purchase and transported the Reins of Hope Trailer
My horse was utilized during Sessions
I transported horses for use during Sessions
I volunteered the use of my horse and transported horses for use during Sessions.

Single Purchase or Multiple Purchases?

Single
Multiple Purchases

Date of Purchase?

List Dates of Purchase and description of items.

Description of items purchased

One Transport or Multiple Transports?

One Transport
Multiple Transports

Date of Transport?

List the Dates and Reason for the transportExample

Reason for Transport?

How many personal horses were utilized during Reins of Hope Sessions?

1
2
3
4

How many sessions was your horse utilized for?

1
2
3
4
5
6

List the Name(s) of your Horse(s)

Single Transport or Multiple Transports?

One Transport
Multiple Transports

What date did you transport horses?

List the Dates you transported horses for use during Reins of Hope Sessions

Total Reimbursement Amount Requested

Send Receipts To
Reins of Hope Treasurer
303 27th St
Spirit Lake, IA 51360