ASCMC - SERVICE

Organization and Account Holder Information

Name: Phone:

Position: Email:

School: CMC CGU HMC PIT POM SCR Organization: ASCMC: CO Chair FundASCMC: DAC FundASCMC: General FundASCMC: President's FundASCMC: SAC FundASCMC: SenateASCMC: Senate - Student TripsASCMC: SLC GeneralCLUBS: 5C:After School SpecialsCLUBS: 5C:Amnesty International of the 5CsCLUBS: 5C:Arabic Language ClubCLUBS: 5C:Asciepius Health JournalCLUBS: 5C:Baha'I ClubCLUBS: 5C:Black Men's ForumCLUBS: 5C:Capoeira ClubCLUBS: 5C:CCWRFCCLUBS: 5C:CESCLUBS: 5C:CheerCLUBS: 5C:Chijnaya ClubCLUBS: 5C:Chinese Student AssociationCLUBS: 5C:Christian and BlackCLUBS: 5C:Circle KCLUBS: 5C:Claremont Bible FellowshipCLUBS: 5C:Claremont Bocce ClubCLUBS: 5C:Claremont College RepublicansCLUBS: 5C:Claremont Colleges Badminton ClubCLUBS: 5C:Claremont Colleges Ballroom Dance CompanyCLUBS: 5C:Claremont Colleges Handball TeamCLUBS: 5C:Claremont Colleges Muslim Student's AssociationCLUBS: 5C:Claremont Colleges STANDCLUBS: 5C:Claremont ConnectionCLUBS: 5C:Claremont Consulting GroupCLUBS: 5C:Claremont Finance ConferenceCLUBS: 5C:Claremont Pre-Law ClubCLUBS: 5C:Claremont Surfers AssociationCLUBS: 5C:Criminal Justice NetworkCLUBS: 5C:Cycling ClubCLUBS: 5C:Dance CompanyCLUBS: 5C:Democrats of the Claremont CollegesCLUBS: 5C:Dis/differently-abled Student NetworkCLUBS: 5C:DruidsCLUBS: 5C:EKTACLUBS: 5C:Equestrian TeamCLUBS: 5C:Extravaganza MagazineCLUBS: 5C:Figure Drawing ClubCLUBS: 5C:Figure Drawing ClubCLUBS: 5C:Free Culture 5CCLUBS: 5C:HillelCLUBS: 5C:Hindu SocietyCLUBS: 5C:Hip Hop Dance TeamCLUBS: 5C:HMC Science BusCLUBS: 5C:HooptasticCLUBS: 5C:Hui Laule'a (Hawaii Club)CLUBS: 5C:International ClubCLUBS: 5C:International FestivalCLUBS: 5C:Intervarsity Christian FellowshipCLUBS: 5C:Jewish Mentor ProgramCLUBS: 5C:Jewish Student UnionCLUBS: 5C:Korean American Students AssociationCLUBS: 5C:KSPCCLUBS: 5C:Labor Solidarity NetworkCLUBS: 5C:Libertarians of the Claremont CollegesCLUBS: 5C:Lindy Hop TeamCLUBS: 5C:Marathon ClubCLUBS: 5C:Mariachi ClubCLUBS: 5C:Men's LacrosseCLUBS: 5C:Men's RugbyCLUBS: 5C:Men's Ultimate FriseeCLUBS: 5C:Men's VollyeballCLUBS: 5C:Midnight EchoCLUBS: 5C:Mood Swing A CappellaCLUBS: 5C:On TapCLUBS: 5C:On The LooseCLUBS: 5C:On The SpectrumCLUBS: 5C:Organic FarmCLUBS: 5C:Pan-African Student AssociationCLUBS: 5C:PasswordsCLUBS: 5C:PC Men's Blue and WhiteCLUBS: 5C:Peace and JusticeCLUBS: 5C:Physics Club of the Claremont CollegesCLUBS: 5C:Prayers About Gods and Nature (PAGAN)CLUBS: 5C:Psi Chi Psychology Honors SocietyCLUBS: 5C:QQAMPCLUBS: 5C:Quiz Bowl ClubCLUBS: 5C:Racquetball ClubCLUBS: 5C:Rare DiamondsCLUBS: 5C:Red Cross ClubCLUBS: 5C:RingersCLUBS: 5C:Roller Hockey ClubCLUBS: 5C:Rotaract of the Claremont CollegesCLUBS: 5C:ShadesCLUBS: 5C:Sketch ComedyCLUBS: 5C:Ski Club (Skeeze)CLUBS: 5C:Student Claremont Entertainment MafiaCLUBS: 5C:Students for the Bernard Field StationCLUBS: 5C:Students of Color Alliance (SOCA)CLUBS: 5C:Studio 47CLUBS: 5C:The Claremont Colleges Psyko TaikoCLUBS: 5C:Triathlon ClubCLUBS: 5C:V-Day ClaremontCLUBS: 5C:Vegan Vegetarian AssociationCLUBS: 5C:VOX Voices of Planned ParenthoodCLUBS: 5C:Without a BoxCLUBS: 5C:Women in ScienceCLUBS: 5C:Women's Blue and WhiteCLUBS: 5C:Women's Club VolleyballCLUBS: 5C:Women's Ultimate FrisbeeCLUBS: CMC:Asian Pacific American MentorsCLUBS: CMC:Boxing ClubCLUBS: CMC:Christian FellowshipCLUBS: CMC:CIVITASCLUBS: CMC:Claremont Accounting AssociationCLUBS: CMC:Claremont FCCLUBS: CMC:Claremont Healthy Eating and FitnessCLUBS: CMC:Claremont International Relations SocietyCLUBS: CMC:Claremont PortsideCLUBS: CMC:Cultural Awareness AdvocatesCLUBS: CMC:Environmental CrusadersCLUBS: CMC:Knitting For The NeedyCLUBS: CMC:Latin American Business CouncilCLUBS: CMC:Latino Student ForumCLUBS: CMC:Liberal Arts SocietyCLUBS: CMC:Liberty's Last StandCLUBS: CMC:Mock TrialCLUBS: CMC:Model United NationsCLUBS: CMC:Next Big ThingCLUBS: CMC:Populus ChristiCLUBS: CMC:Sigma Theta ChiCLUBS: CMC:Student Alumni Relations CommitteeCLUBS: CMC:Taiwanese American Student AssociationCLUBS: CMC:The CMC Paintball CoalitionCLUBS: CMC:The VernacularCLUBS: CMC:Under The LightsCLUBS: CMC:Volunteer Action ClubCLUBS: CMC:Winston Churchill SocietyCLUBS: CMC:Women's ForumCLUBS: CMC:Wrestling ClubDORMS: ApartmentsDORMS: ApplebyDORMS: AuenDORMS: BeckettDORMS: BensonDORMS: BergerDORMS: BoswellDORMS: Claremont HallDORMS: FawcettDORMS: GreenDORMS: MarksDORMS: PhillipsDORMS: StarkDORMS: WohlfordOTHERS: Accounting ExpenseOTHERS: AyerOTHERS: Band FundOTHERS: BookkeeperOTHERS: Cable SubscriptionOTHERS: Class of 2009OTHERS: Class of 2010OTHERS: Class of 2011OTHERS: Class of 2012OTHERS: Class of 2013OTHERS: ForumOTHERS: MadrigalsOTHERS: Monte CarloOTHERS: Office SuppliesOTHERS: President's Room and BoardOTHERS: Private SecurityOTHERS: Student SecurityOTHERS: Summer ExpensesOTHERS: Wedding Party

Payee Information

Name: Email: Phone:

School: CMC CGU HMC PIT POM SCR OTHER Box# (if applicable):

Address (if not on campus)

Street: City: State: Zip:

Date of Purchase(s) or Event(s): Time: Approximate Number of Participants:

Description of activities, purchase, or service obtained :

Please follow the following format with the box below:
Good 1, Price
Good 2, Price
Good 3, Price
etc...

Line item breakdown of expenses :

Does this request include non-perishable items such as equipment? No Yes

Any equipment purchased with ASCMC funds becomes the property of ASCMC and must be surrendered upon the request of an ASCMC Officer. Failure to comply is considered theft, and offenders will be prosecuted under ASCMC and/or CMC codes and procedures, and/or under local, state and federal law.

Source of Funds:

Club Budget: Select Club After School Specials Amnesty International of the 5Cs Arabic Language Club Asciepius Health Journal Asian Pacific American Mentors Baha'I Club Black Men's Forum Boxing Club Capoeira Club CCWRFC CES Cheer Chijnaya Club Chinese Student Association Christian and Black Christian Fellowship Circle K CIVITAS Claremont Accounting Association Claremont Bible Fellowship Claremont Bocce Club Claremont College Republicans Claremont Colleges Badminton Club Claremont Colleges Ballroom Dance Company Claremont Colleges Handball Team Claremont Colleges Muslim Student's Association Claremont Colleges STAND Claremont Connection Claremont Consulting Group Claremont FC Claremont Finance Conference Claremont Healthy Eating and Fitness Claremont International Relations Society Claremont Portside Claremont Pre-Law Club Claremont Surfers Association Criminal Justice Network Cultural Awareness Advocates Cycling Club Dance Company Democrats of the Claremont Colleges Dis/differently-abled Student Network Druids EKTA Environmental Crusaders Equestrian Team Extravaganza Magazine Figure Drawing Club Figure Drawing Club Free Culture 5C Hillel Hindu Society Hip Hop Dance Team HMC Science Bus Hooptastic Hui Laule'a (Hawaii Club) International Club International Festival Intervarsity Christian Fellowship Jewish Mentor Program Jewish Student Union Knitting For The Needy Korean American Students Association KSPC Labor Solidarity Network Latin American Business Council Latino Student Forum Liberal Arts Society Libertarians of the Claremont Colleges Liberty's Last Stand Lindy Hop Team Marathon Club Mariachi Club Men's Lacrosse Men's Rugby Men's Ultimate Frisee Men's Vollyeball Midnight Echo Mock Trial Model United Nations Mood Swing A Cappella Next Big Thing On Tap On The Loose On The Spectrum Organic Farm Pan-African Student Association Passwords PC Men's Blue and White Peace and Justice Physics Club of the Claremont Colleges Populus Christi Prayers About Gods and Nature (PAGAN) Psi Chi Psychology Honors Society QQAMP Quiz Bowl Club Racquetball Club Rare Diamonds Red Cross Club Ringers Roller Hockey Club Rotaract of the Claremont Colleges Shades Sigma Theta Chi Sketch Comedy Ski Club (Skeeze) Student Alumni Relations Committee Student Claremont Entertainment Mafia Students for the Bernard Field Station Students of Color Alliance (SOCA) Studio 47 Taiwanese American Student Association The Claremont Colleges Psyko Taiko The CMC Paintball Coalition The Vernacular Triathlon Club Under The Lights V-Day Claremont Vegan Vegetarian Association Volunteer Action Club VOX Voices of Planned Parenthood Winston Churchill Society Without a Box Women in Science Women's Blue and White Women's Club Volleyball Women's Forum Women's Ultimate Frisbee Wrestling Club $ CO: $ Executive Board General Fund: $
Senate: $ Senate Trips: $ DAC: $ SAC: $ SLC: $ President's Fund: $

Other: Select Other Accounting Expense Ayer Band Fund Bookkeeper Cable Subscription Class of 2009 Class of 2010 Class of 2011 Class of 2012 Class of 2013 Forum Madrigals Monte Carlo Office Supplies President's Room and Board Private Security Student Security Summer Expenses Wedding Party $

Dormitories

Is TNC

Appleby: Apartments: Claremont: Auen: Beckett: Benson: Berger: Boswell: Fawcett: Green: Marks: Phillips: Wohlford: Stark:

Amount for:

Supplies $ Services $ Alcohol (up to 15% alcohol by volume) $ Total $

Under penalities of perjury, I declare that I have exmained this request and to the best of my knowledge and belief, it is true, correct, and complete.

Initial Here:

After you submit, you will be presented with a transaction number. Please put all your receipts in an envelope labeled with the transaction number and turn it into Storyhouse #1540. When your request is approved, the payee on this form will receive a check in their box.