Payment Authorization & Reimbursement

PAYMENT AUTHORIZATION & REIMBURSEMENT FORM

SPHS PTSA
Person Requesting*
Check payable to
If different than Person Requesting
Department/Program/Activity*
Email*
Phone*
PTA Board Member?*

YesNo
PTA Position *

Expenses*

	Date	Amount ($)	Product/Service Description	Vendor/Store name
1
2
3
4
5
6
7
8
9

Total Amount ($)*
auto calculated
Receipts

Files under 1MB work best! Please make sure all amounts, descriptions, vendor names are clearly legible.
Cancelof
Delivery Instructions

Deliver to teacher/staff inbox at SPHSMail check to requestor/vendorOther (add instructions below)
Mailing Address*

Name

Street Address

CityState / Province

Postal / Zip Code
Other (Instructions)*

For Treasurer Use Only
Check#
Check Issued

MonthDayYear
For Treasurer Use ONLY

Please click the SAVE button after entering check information.

Do NOT resubmit the form.
Should be Empty: