Northwestern Middle School PTO Check Reimbursement Form

Northwestern Middle School PTO Check Reimbursement Form
Before starting this form, please be prepared to upload your receipt(s). PDF Files are preferred. This form will be sent to the PTO Presidents and/or appropriate VP for approval. Please allow 1-2 weeks for approval and payment.
Requested by

First NameLast Name
Email*
example@example.com
Payee Name (if different from above)
Payment Instructions*

Deliver Check to NMS Front OfficeMail Check (provide address below)Request payment via PTO Debit Card (provide details below and attach invoice)
Payee Address (if applicable)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Instructions for Debit Card Request (include contact person, phone number, and link to pay if available)
Expense Details
TOTAL Reimbursement Amount*
You may submit receipts for up to three expense categories. All expenses falling under the same category should be bundled together. For example, if you seek reimbursement for multiple staff appreciation events, please only use one "Expense Category 1," below.
Expense Category 1*
Description of Expenses for Category 1, above (ex: food and decor for pre-planning day staff lunch)*
List Each Receipt and Amount Sought for Reimbursement in Category 1, above (ex: Target $15, Costco $29)*
Expense Category 2 (only if seeking expenses from more than one category)
Description of Expenses for Category 2, above (ex: food and decor for pre-planning day staff lunch)
List Each Receipt and Amount Sought for Reimbursement in Category 2, above (ex: Target $15, Costco $29)
Expense Category 3 (only if seeking expenses from more than two categories)
List Each Receipt and Amount Sought for Reimbursement for Category 3, above (ex: Target $15, Costco $29)
List Each Receipt and Amount Sought for Reimbursement in Category 3, above (ex: Target $15, Costco $29)
Please Upload Receipt(s)*

If possible, multiple receipts should be combined into one PDF.
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Declaration:

I hearby declare that the information provided in this reimbursement form is accurate and the expenses were incurred in connections with Northwestern PTO activities. I understand reimbursement is subject to approval and compliance with the organization's reimbursement policies.
Signature*

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Northwestern Middle School PTO Check Reimbursement Form

Expense Details