Company Name *

Company Phone Number *

Company Street Address *

Company Street Address Two

City *

State * AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

Zip *

Alula Account Number

First Name *

Last Name *

Program Admin Email *

Program Admin Phone Number *

Request Type * Pre-approval Reimbursement Customized Marketing Service

Expense Information * Expense Type (Check one; bolded items require pre-approval) Branded sales & marketing literatureAlula demo productBranded promotional items
(shirts, hats, bags, door hangers)Customizable device decals – branded labels for panel and device housingsAdvertising
(newspaper, radio, internet, television, billboard, vehicle wrap/decal, yard signs, direct & email campaigns)Website developmentEvents and sponsorships (tradeshows)Customized marketing service Please provide description & desired date for work to be completed.

Description of expense or Customized marketing service * (When requesting tailored marketing services, please provide description and desired date for work to be completed. Leave blank: Invoice number, Total amount of expense, Requested amount to be reimbursed).

Date expense was/ will be incurred

Invoice number

Total amount of expense

Requested amount to be reimbursed

Name of 3rd party providing the service or work

Preferred Distributor *

Distributor City

Distributor State

Your Customer ID with the Preferred Distributor

Comments

Note: When submitting this reimbursement form, please attach images of receipts, pictures of cobranded literature/promotional items, etc. to the email.