Reimbursement Request Form

Instructions:

Please fill out completely with description of reimbursement and breakdown of expenses.
Attach a file/picture/scan of each receipt or supporting documentation.
A receipt of your submitted request will be e-mailed to you (please keep for your records).
A check will be mailed directly to your provided home address once reimbursement is approved.
Questions? Please refer to the PTO Treasurer.

Please remember: As a sales tax exempt organization, we cannot reimburse sales tax, so please give all vendors a copy of our sales tax exemption form to avoid being charged sales tax when you make your purchase.


Reimbursement Information
Make check payable to: Grand total amount for reimbursement: Check here if you would like your check reimbursement to be mailed to school. Address Telephone E-mail

Expense #1
Vendor Expense category Amount Brief description of items purchased Attach receipt

Expense #2
Vendor Expense category Amount Brief description of items purchased Attach receipt

Expense #3
Vendor Expense category Amount Brief description of items purchased Attach receipt

Expense #4
Vendor Expense category Amount Brief description of items purchased Attach receipt

Expense #5
Vendor Expense category Amount Brief description of items purchased Attach receipt