Tiffany Park PTA Reimbursement Request

Tiffany Park PTA Reimbursement Request

Questions? Email Treasurer@tiffanyparkpta.org
1. Complete this form and submit it to the PTA Treasurer within 60 days of purchase or event. Reimbursement requests older than 60 days may not be processed.

2. Include all receipts. Reimbursement will NOT be issued without receipts. You can upload scanned copies of receipts or take a picture using this form. If you need help with this, please email treasurer@tiffanyparkpta.org for support or complete a paper form and leave in the PTA Mailbox in the office.
Date

MonthDayYear
Date
Submitted By

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Confirm By

EmailText at # Above
Please List all Items purchased, amount paid without the $ and the event, function or budget Item.
Item Purchased
Amount
Function/Event/Budget Item
Item Purchased
Amount
Function/Event/Budget Item
Item Purchased
Amount
Function/Event/Budget Item
Item Purchased
Amount
Function/Event/Budget Item
Item Purchased
Amount
Function/Event/Budget Item
TOTAL REIMBURSEMENT REQUESTED
Upload Receipts

Cancelof
Take Photo of Receipts
Preferred Payment Option

CheckZelle
Make Check Payable to (if selecting check):
For check requests, please indicate how you would like the check delivered to you:
If selecting Zelle, Name and Email/phone number associated with Zelle
ADMIN USE: Treasurer's Signature

Clear
ADMIN USE: 2ND Signature

Clear
Should be Empty: