PTO Check Request and Reimbursement Form
Submitter Name
*
First Name
Last Name
Submitter Email
*
example@example.com
Submitter Phone Number
-
Area Code
Phone Number
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Pay to the order of:
*
Please list who should receive payment
Amount (to be paid/reimbursed)
*
Reminder: The PTO does not reimburse for sales tax as we are a 501c3 organization. If you need a certificate of exemption, please visit https://www.juliagreen.org/pto
Invoice Number, if appliable
Type in invoice #
Expense Category (e.g. Carnival, 1st Grade Team Supplies, Grandparents Day)
*
Please submit the category for your expenditure
Address to mail payment
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Description & Comments
Please add a description of the item(s) that are you requesting reimbursement
Upload receipts/payments. More than 3 receipts should include an itemized excel breakdown
*
Browse Files
Please upload all receipts and payments to facilitate payment.
Cancel
of
For PTO purposes only - PTO Treasurer Approval
Form of Payment (For PTO Purposes only)
Check
ACH
What type of account?
Please Select
Checking
Savings
Other
Routing Number
Account Number
For PTO purposes only - Check number and date
Submit
Should be Empty: