PTA Expense/Reimbursement Form

Instructions:

1. Fill out completely with a description of the payment/reimbursement and breakdown of expenses by budget category (missing info will delay payment). Attach one file with copies of all receipts per budget expense, preferably a PDF.
2. Specify to whom and where the check should be delivered.
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)

Expense/Reimbursement Information

Check Requestor:

Requestor Phone Number:

Each check to be paid requires a separate request form.

Select for a check to be paid directly to a vendor/service provider Select for a reimbursement for expenses already paid

Check Payable To:

Total Amount of Check:

Please mail to vendor/payee Please drop off at my house Please mail to my house Please leave it in my school mailbox/PTA folder I will pick it up from the treasurer

If check is to be mailed or dropped off, please provide the address.

Expenses for Reimbursement

Expense #1 Information

Expense 1 Amount:

Account to Be Charged:

Expense Is For:

Place of Purchase:

Attach Receipts for Expense 1

Please attach one file with copies of all receipts related to expense #1.

Expense #2 Information (if applicable)

Expense 2 Amount:

Account to Be Charged:

Expense Is For:

Place of Purchase:

Attach Receipts for Expense 2

Please attach one file with copies of all receipts related to expense #2.

Expense #3 Information (if applicable)

Expense 3 Amount:

Account to Be Charged:

Expense Is For:

Place of Purchase:

Attach Receipts for Expense 3

Please attach one file with copies of all receipts related to expense #3.

Upon submission, a copy of your request will be sent to the Treasurer and President for review and approval. If you have any questions, please email the Treasurer at treasurer@wallacepta.org.

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