Check Request Form - Claremont Immersion Elementary School Pta

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Claremont Immersion School
Check Request Form
Submit one form for each Budget Line Item deposit.
Date Submitted:
Requested By:
Contact Info for Requestor:
Check Payable To:
Amount Requested: $
Purpose/Event or Budget
Line Item:
Description of Expenses:
EB Member or
Committee Chair
Authorizing Expense
Expense Reimbursement:
Vendor Payment:
Cash Advance:
Signature of Requestor: ______________________________________________________________
INSTRUCTIONS
-- Expense Reimbursements / Vendor Payments: Check Request Form submissions must include ALL
receipts, vendor invoices and packing slips (if goods were received).
-- Cash Advance Requests: A check will be written to the Check Payable name for the amount
requested. Petty cash must be re-deposited using the Bank Deposit Form.
Please submit to the PTA Treasurer, Beth Addington (, 571-276-4042).
-- Drop documents in the PTA Treasurer's box in the CIS office
-- Mail documents to CIS (ATTN: PTA Treasurer, 4700 S Chesterfield Rd, Arlington, VA 22206)
-- Bring documents to a monthly PTA meeting
FOR TREASURER USE ONLY
Date Rcvd:
Budget Line Item:
PTA Officers
_____________________________
_____________________________
Approving Check:
Name
Signature
Check #:
Check Date:
Check Amount: $
Treasurer Signature
_____________________________
and Notes:
Signature
Balance after
FY
$________
Spend to Date
$____________
current
$____________
Budget
request

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