Debit Card Transaction Form
To be submitted with photo of receipt for any charge or credit made to PTO debit card.
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Month
*
Please Select
January
February
March
April
May
June
July
August
September
October
November
December
Type of Transaction
Please Select
Deposit
Withdrawal
Month
Date Purchased
*
-
Month
-
Day
Year
Date
Date Submitted
*
-
Month
-
Day
Year
Date
Project/Category
*
Project/Category
Purchase Approval
*
Please Select
Approved in Budget
Approved in Meeting
Name of Vendor
*
Amount of Purchase
*
Upload Receipt
Browse Files
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Notes or Additional Comments
Please verify that you are human
*
Submit
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