Brookdale Elementary PTA Reimbursement Request

Brookdale Elementary PTA Reimbursement Request

Questions? Email Treasurer.brookdalepta@gmail.com
1. Please only submit reimbursements for one Event/Budget item at a time. If you are submitting for multiple, please fill out an additional form. The keeps clean book keeping records for the PTA.

2. Complete this form and submit to the PTA Treasurer within 60 days of purchase or event. Reimbursement requests older than 60 days may not be processed.

3. Include all receipts. Reimbursements will NOT be issues without receipts. You can upload scanned copies (photos from your phone) or you can take a picture using this form. If you need help with this, please email Kelly Casmer at Treasurer.brookdalepta@gmail.com.
Today's 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
Function/Event/Budget Item*
Summary of Purchase

Please list all items purchased with amount paid for each retailer you are submitted receipts. Example, you have receipts from Target and Walmart then fill out two sections. Do NOT include tax in your reimbursement amounts. That must be deducted due to our tax status.
Total Reimbursement Request Amount*
ie 500
Items Purchased from Retailer 1*
Amount
i.e 25 (no $ symbol)
Items Purchased from Retailer 2
Amount
i.e 25 (no $ symbol)
Items Purchased from Retailer 3
Amount
i.e 25 (no $ symbol)
Items Purchased from Retailer 4
Amount
i.e 25 (no $ symbol)
Upload Recieipts

Cancelof
Take Photo of Receipts
Preferred Payment Option*

ZelleCheck
If selecting Zelle, Name + email/phone number associated with Zelle:
Make check payable to (if check was selected):
For check requests, please indicate how you would like check delivered to you:
i.e. child's name + classroom or home address
Should be Empty:

Brookdale Elementary PTA Reimbursement Request

Summary of Purchase