Check Request/Reimbursement Request Form

Instructions:

Please fill out completely with description of reimbursement and breakdown of expenses.
Attach a file/picture/scan of each receipt or supporting documentation.
A receipt of your submitted request will be e-mailed to you (please keep for your records).
The treasurer will e-mail you when your check is ready to be picked up at the school or has been mailed to you.
Questions? Please e-mail our treasurer at jyanguiano@hotmail.com.


Reimbursement Information
Who is requesting the reimbursement? Check made payable to: Email of requestor: How should the check be delivered?* Mailing address for check? (If Pickup, please put N/A) Grand total amount for reimbursement: Committee/Event* Description Description/Purpose

Expense #1
Vendor Amount Brief description of items purchased Attach receipt

Expense #2
Vendor Amount Brief description of items purchased Attach receipt

Expense #3
Vendor Amount Brief description of items purchased Attach receipt

Expense #4
Vendor Amount Brief description of items purchased Attach receipt

Expense #5
Vendor Amount Brief description of items purchased Attach receipt

Reimbursement Information
Date Check Needed (please allow at least 1-2 weeks if possible):