Weaver Elementary PTA Reimbursement Form

Instructions:

1. Fill out completely with the description of reimbursement and breakdown of expenses by budget category (missing info will delay payment). Attach one file with copies of all receipts, preferably a PDF.
2. Specify if the check should be placed in your file folder or mailed to the vendor
3. A receipt of your submitted request will be emailed to you (keep for your records)

Item Description Price Qty

Reimbursement Information

Select Type:

Check Payable To:

Total Amount For Reimbursement:

Should check be placed in the folder or mail to vendor?

If check is to be mailed, provide the address.

EXPENSES for REIMBURSEMENT

EVENT/COMMITEE/DEPARTMENT for Expenses

Other(please list budget line)

How many items(expenses) are you listing for this Event
Every event/department needs a separate reimbursement form to be submitted Do not combine expenses from multiple committees/dept/events. more

$0.00

#1	$Expense Amount$ Expense Description Vendor/Store Name for Expense Event/Committee/Line for this Expense Other (list budget line item)	copy
#2	$Expense Amount$ Expense Description Vendor/Store Name for Expense Event/Committee/Line for this Expense Other (list budget line item)
#3	$Expense Amount$ Expense Description Vendor/Store Name for Expense Event/Committee/Line for this Expense Other (list budget line item)
#4	$Expense Amount$ Expense Description Vendor/Store Name for Expense Event/Committee/Line for this Expense Other (list budget line item)
#5	$Expense Amount$ Expense Description Vendor/Store Name for Expense Event/Committee/Line for this Expense Other (list budget line item)
#6	$Expense Amount$ Expense Description Vendor/Store Name for Expense Event/Committee/Line for this Expense Other (list budget line item)
#7	$Expense Amount$ Expense Description Vendor/Store Name for Expense Event/Committee/Line for this Expense Other (list budget line item)
#8	$Expense Amount$ Expense Description Vendor/Store Name for Expense Event/Committee/Line for this Expense Other (list budget line item)
#9	$Expense Amount$ Expense Description Vendor/Store Name for Expense Event/Committee/Line for this Expense Other (list budget line item)

Attach Receipts

Please attach one file with copies of all receipts

Receipt or Invoice Submitted?

Reason for not including receipt or invoice:

Please note: If an invoice or receipt is not submitted, reimbursement will be delayed until all items are verified.

Notes

SIGNATURES

COMMITTEE CHAIR SIGNATURE

All Committee Chairs must sign Reimbursement forms

For Treasurer's Use

Amount:

Date Check Issued:

Check Number:

Approved By:

Date Approved:

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Weaver Elementary PTA Reimbursement Form

Reimbursement Information

For Treasurer's Use

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