Expense Reimbursement/payment/check Request Form


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:
Staples Receipt for Administrative Supplies
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


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Parent category: Business