Request for Payment / Reimbursement

Paly PTSA Request for Payment / Reimbursement
Instructions:

1) Complete form 2) Upload copy of receipts 3) Submit. IMPORTANT: Please double check your phone/email for Zelle payments!!! If requesting a payment for a vendor, please upload ACH payment instructions. In case of any problems or questions, please contact: Paly PTSA Treasurer - Orit Vidas-Horovitz, 2025-26 (treasurer@palyptsa.org)
Date*

MonthDayYear
Requestor Name:*

First NameLast Name
Requestor Email*
Requestor Phone:*

Area CodePhone Number
Payment Option:*

ZelleACH (for vendors only. Please upload instructions)Other (Please provide additional information in special instructions)
How should we look you up in Zelle?

PhoneEmail
Payee (if other than Requestor):

First NameLast Name
Mailing Address for Check:

Street Address

Street Address Line 2

CityState

Zip
$ Amount Requested*
Attach Receipt(s) (.pdf, .jpg, ,gif, .png files)

Upload a File

Cancelof
Expense Category Code 2025-26 (Choose a numbered category)*
Description of Purchase (Be Specific)*
Special Instruction (if any)
Should be Empty:

Paly PTSA Request for Payment / Reimbursement