(PLEASE EXPLAIN 'WHAT' YOU ARE APPLYING FOR -- DO NOT LEAVE BLANK)
DIRECT REIMBURSEMENT: If you prefer to use the reimbursement program, please send in proof that you have already paid for purchases. You may send in proof such as: a cancelled check from bank or store receipts showing proof of payment. We cannot reimburse for credit card statements, cash back at store, gift card, alcohol, cigarettes, restaurant tip money not recorded on receipt, Benny card purchases or utility bills that the Sr. Energy program paid. Please allow 10-14 days for processing. If you have direct deposit on file with the tribe, please make sure all banking information is current. If there have been any changes, you will need to submit the proper paperwork.
VENDOR: Please list each vendor, provide a copy of that bill or invoice, and state the amount you request we send to that vendor. It is recommended that each $300.00 allotment is used in full at once if paying one or multiple bills. You may be required to obtain a W9 if the vendor has not previously been paid by the tribe.