Reimbursement Request Form 26-27

Fill out this form if you have purchased something on behalf of the Pacific Sky PTA and need to be reimbursed.

ATTACH ALL RECEIPTS TO THIS REQUEST. IF YOU HAVE 5+ RECEIPTS, SUBMIT A SECOND FORM BUT PROVIDE THE SAME REIMBURSEMENT TOTAL REQUEST ACROSS FORMS.

Instructions:

Fill out completely with descriptions of each receipt and expense breakdown
Required fields are marked with *
Provide a mailing address if check cannot be picked up at Pacific Sky
Allow 4 weeks after submission to receive reimbursement as all request must be approved in PTA meeting before a check is cut
The PTA president or treasurer will e-mail you when your check is ready. Pick-up is typically at the front office.
Questions? Please e-mail treasurer@pacificskypta.org

Make check payable to*:

Payee Email*

Submitter Name:

If different than payee

Submitter Email

If different than payee

Payee Address

If want check mailed

Payee City, State Zipcode

Payee Telephone

Expense Account: Committee/Event/Category*

Expenditure Details (write country if Int'l Night):

1. Receipt Name/Store*

1. Receipt Items/Services*

1. Receipt Amount ($)*

1. Attach Receipt*

2. Receipt Name/Store

2. Receipt Items/Services

2. Receipt Amount ($)

2. Attach Receipt

3. Receipt Name/Store

3. Receipt Items/Services

3. Receipt Amount ($)

3. Attach Receipt

4. Receipt Name/Store

4. Receipt Items/Services

4. Receipt Amount ($)

4. Attach Receipt

5. Receipt Name/Store

5. Receipt Items/Services

5. Receipt Amount ($)

5. Attach Receipt

Total Amount for Reimbursement ($)*:

E-Signature*

Signing certifies that all submitted expenses are accurate, legitimate, and comply with the PTA event policy.

Date*

MM/DD/YYYY - allow 4-8 weeks for reimbursement