Peruvian Park Elementary PTA Reimbursement Request

Peruvian Park Elementary PTA Reimbursement Request

Questions? Email: PeruvianParkPTA@gmail.com
1. Complete this form and submit it to the PTA Treasurer within 30 days of purchase or event.

2. Include all receipts. Reimbursements will NOT be issued without receipts. You can upload scanned copies of receipts or take a picture using this form.
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Submitted By

First NameLast Name
Phone Number
Format: (000) 000-0000.
E-mail
Your E-mail Address
Confirm By
Expense Detail

Expenses List (that goes with receipts)

Rows	Vendor	Event	Items Purchased	Pre Tax Amount	Sales Tax Amount	TOTAL
1
2
3
4
5
6
7
8
9
10

TOTAL REIMBURSEMENT REQUEST ($)
Sales Tax Total ($)
How do you want Reimbursement?
Mailing Address (if applicable)
Take a Photo of Receipts
Take a Photo of Receipts
Take a Photo of Receipts
Take a Photo of Receipts
Take a Photo of Receipts
Take a Photo of Receipts
Take a Photo of Receipts
Take a Photo of Receipts
Take a Photo of Receipts
Take a Photo of Receipts
OR
Upload Receipts Here
Upload Receipts Here
Upload Receipts Here
Upload Receipts Here
Upload Receipts Here
Upload Receipts Here
Upload Receipts Here
Upload Receipts Here
Upload Receipts Here
Upload Receipts Here
Upload Receipts Here
ADMINISTRATION USE
TREASURER SIGNATURE

_____________________________________

SECOND SIGNATURE

_____________________________________

PRINCIPAL SIGNATURE

_____________________________________

CHECK NUMBER___________________DATE WRITTEN________________
Should be Empty: