2020-2021 Check Request Form

Check Request Form

Longfellow Middle School PTA
Prepared By*

First NameLast Name
Email*
Budget Line Item*
Description*
Please enter the total amount requested from each receipt/invoice or itemize the reimbursable expenses. After each entry is made another line will appear up to 10 lines. If you need more than 10 lines, please submit an additional form. The total will be calculated below.
1. Description*
1. Amount ($)*
2. Description
2. Amount ($)
3. Description
3. Amount ($)
4. Description
4. Amount ($)
5. Description
5. Amount ($)
6. Description
6. Amount ($)
7. Description
7. Amount ($)
8. Description
8. Amount ($)
9. Description
9. Amount ($)
10. Description
10. Amount ($)
Total
Amount Requested ($)
Check Payable to:*
Address to mail check:*
Enter the message as it's shown*
After clicking Submit, please check your email for the final steps to complete your request.
Treasurer Approval
Date
Check #
Should be Empty: