Expense Reimbursement/payment/check Request Form printable pdf download

Expense Reimbursement/payment/check Request Form

BENNETT-HEMENWAY PTO

Expense Reimbursement/Payment/Check Request Form

Today’s Date: __________________________________________________________________

Payee Name:___________________________________________________________________

Mailing Address:________________________________________________________________

How/where should this check be delivered? __________________________________________

______________________________________________________________________________

Check Due Date:________________________________________________________________

Event or Expense Category:_______________________________________________________

Event Chair Name/Approval: _____________________________________________________

Individual Making Request (Name & contact info):____________________________________

______________________________________________________________________________

Please list receipts and/or contract with explanation of expense:

Amount:

Example:

Staples Receipt for Administrative Supplies

$xx.xx

Total Requested:

Please list and attach all receipts and/or executed contracts (keep copy for yourself); have your event chair approve

the request; and submit the request by placing it in the green treasurer folder in the PTO mailbox in the Ben-Hem

Office. It is important that all reimbursement and check requests be submitted no later than the last day of the

current school year.

Please call Amy Keith at (508) 650-0629 or

with questions or concerns.

Form Updated 3/12

Expense Reimbursement/payment/check Request Form