Canyon Rim PTA Check Request

Canyon Rim PTA Check Request
Questions? Email treasurer@canyonrimpta.org

1. Use this form to request payment to a vendor. This is not a reimbursement request

2. Attach an invoice or contract as documentation.

3. All requests must be pre-approved and within the approved budget.

4. Please leave this form in the PTA mailbox in the school office.
Requestor Information
Submitted By:
Date

MonthDayYear
Date
Email:
Phone
Format: (000) 000-0000.
Payee (Vendor) Information
Vendor Name
Email:
Phone
Format: (000) 000-0000.
Payment Details
Amount Requested
Make Check Payable To
Purpose of Payment
Event/Program (if applicable)
Budget Line Item
Date Payment is Needed

MonthDayYear
Date
Date Payment is Needed
Requestor Signature
Date

MonthDayYear
Date
Check Distribution
Give Check to
Check Distribution
Mail Check to
Check Distribution
Received By:
Date Received:

MonthDayYear
Date
Treasurer Use Only
Check Date

MonthDayYear
Date
Check
Amount
Signature
Should be Empty: