Reimbursement Form for PTSA approved expenses

Instructions:

1. Fill out completely with description of reimbursement and breakdown of expenses by budget category (missing info will delay payment). Attach one file with copies of all receipts, PDF or word doc.
2. Specify if the check should be placed in your school mailbox or mailed to the vendor
3. REMEMBER – PTA DOES NOT PAY SALES TAX on items purchased for its use; therefore sales tax will not be reimbursed
4. A receipt of your submitted request will be emailed to you (keep for your records)

Contact Jennifer Eischeid Ajeischeid@gmail.com.

Reimbursement Information

Check Payable To:

Total Amount For Reimbursement:

Should check be placed in your school mailbox or mailed?

If check is to be mailed, provide the address.

Expenses for Reimbursement

Expense 1 - Amount

Committee or budget line item to be charged

Event/Reason for request

Description of items/services purchased

Place of Purchase

Attach Receipts

Please attach one file with copies of all receipts

Approval

Approved By:

Approved by Date:

Treasurer's Notes

(to be completed by the Treasurer)

Date Check Issued

Check Number:

Notes