INSTRUCTIONS
Please email Christian Anaya() all documentation:
1.Completed copy of this form
2. Copy of the paid invoice (invoices not marked PAID by the vendor can be submitted with a copy of a cashed check or bank statement)
3. Artwork or media (must be the actual piece that runs in the publication, not the file that is sent to you when the proofing process is complete)
If you do not receive a confirmation within 48 hours that your request has been received, please contact Christian Anaya(480) 362-4826, ).
Invoices are processed on the 15th of each month and can take up to 60 days to be reimbursed.
CONTACT INFO / 1 / Franchisee Name / Franchisee Email / Franchisee Phone
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2 / Make check payable to / AD/RDO Name
3 / Franchisee Mailing Address(include Ste/Unit/Spc #; Bdl #, Fl# if applicable)
LSM EXPENSE INFO / STORE # * / DESCRIPTION / EXPLANATION / VENDOR / AMOUNT*
examples / 20001 / Valpak® Ad Invoice 21212 / Valpak / 1,000.00
20002 / Valpak® Ad Invoice 21212 / Valpak / 1,300.00
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10 / *List all stores requiring reimbursement. Specify the dollar amount to be deducted from each store’s account. Reimbursement amounts not specified will be divided equally among stores listed. / TOTAL
11 / Owner’s Signature
If you are unable to submit your LSM Reimbursement Request via EMAIL, you may submit your LSM Reimbursement Request via MAIL by mailing all documentation specified above to: LSM Reimbursement Request
Attn: Christian Anaya
9311 E. Via De Ventura, Scottsdale, AZ 85258
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FOR INTERNAL PURPOSES ONLYDate of Completed Request / /
Store #Budget
Amount
LSM Reimbursement Request 120517© 2018 Kahala Franchising, L.L.C. All rights reserved. Confidential communication for only Cold Stone Creamery® franchisees. All trademarks referenced in this communication are the property of their respective owners.