PTSA Reimbursement Request Form

Please fill in all fields below in order to submit your reimbursement form.

Requestor's Name:

Date:

Committe/Event:

Please enter the name of the event/committee where the expense was generated.

Phone:

Email Address:

Total Amount:

Please enter the total amount for reimbursement.

Indicate where check should be sent (pick one):

Make check payable to:

Itemization

Please provide a brief description of items purchased.

Receipt(s)

Please upload your receipt(s).

Receipt(s)

Please upload your receipt(s).

Receipt(s)

Please upload your receipt(s).

Submit this completed form and upload original invoice/receipt(s)
All reimbursements must have receipt or invoice
Payment requests need to be turned in within 30 days of expenditure
Reimbursement checks must be cashed within 60 days or check issued date to ensure payment