Canyon Rim PTA Reimbursement Request

Canyon Rim PTA Reimbursement Request

Online Submission
Questions? Email treasurer@canyonrimpta.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.

3. Please leave this form in the PTA mailbox in the school office.
Submitted By:
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Email:
Phone
Format: (000) 000-0000.

Please list all items purchased, amount paid, and the event or budget item.

Rows	Item Purchased	Amount	Event/Budget Item

Total Reimbursement Requested
Make Check Payable To
Check Distribution
Grade
Name
Check Distribution
Address
Other
Received By:
Date Received:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Treasurer Use Only
Check Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Check
Amount
Signature
Should be Empty: