CREATE Reimbursement Request


Complete this form to request purchase approval for CREATE account purchasing only. 


  • Items must be received before submitting the reimbursement.
  • If you plan to submit a receipt for office supplies, chemicals, software, or any other items that a MarketPlace Vendor could supply, your request will be denied, and you will NOT be reimbursed.


Category of Order

Is this reimbursement for food:

Reason for Reimbursement

Why was this not purchased through Market Place?

Be Specific! If the purchase was made for research - make sure to include the type of research, room number, or any other pertinent details.  


Receipt Information

Funding Information

If using a specific grant/personal account for reimbursement, please specify. Enter the Source of Funds, and complete the Cost Center/Fund/Account information in the fields below.

*Express permission from CREATE director required for Other Funding
Please provide account number to expedite the reimbursement

Upload your receipt and bank/card statement below as a PDF

  • You will not be reimbursed for sales tax
  • To help with processing, you must attach a snapshot of the charge from your bank/card statement (the card/bank statement that contains this purchase in your name)
  • Required information includes your name, relevant charge, and the last four digits of the relevant card, if available.  Please black out all other info

Certification Statement

By checking this box, I acknowledge that this serves as my signature and validation of the expenses listed on the reimbursement request with the corresponding receipts attached.

I certify that the expenses are correct, were paid with my personal funds, and have not been paid or reimbursed previously by the university or by any other means. *