Payout Status
PAYMENT AUTHORIZATION/REQUEST FOR REIMBURSEMENT
ATTACH ALL RECEIPTS TO THIS EXPENSE STATEMENT
Name of Payee
*
Vendor Name
*
PTA Position
*
enter "Volunteer" if no official position
Address
*
Street Address
Street Address Line 2
City, State, Zip
State / Province
Postal / Zip Code
Address for Zelle
*
Street Address
Street Address Line 2
City, State, Zip
State / Province
Postal / Zip Code
Telephone
*
Format: (000) 000-0000.
Telephone for Zelle
*
Format: (000) 000-0000.
Email
*
example@example.com
Email for Zelle
*
example@example.com
Expenditure was for:
*
Please Select
Assemblies
Back to School
Book Fair
Classroom Supplies
Family Fun Night
Field Day
Field Trip
Fifth Grade Promotion
Garden Maintenance
Honorary Service Awards
Hospitality - Back to School Night
Hospitality - Honorary Service Awards
Hospitality - Meetings
Hospitality - SAW
Hospitality - Staff Lunch
Hospitality - Volunteers
Ice Cream Social
Kindness Week
Lunch Time Activities
Movie Night
Multicultural Night
Project Cornerstone
Pumpkin Patch
Red Ribbon Week
Reflections
Ruby Bridges Walk
Running Club
Spiritwear
St. Patrick's Day
STEAM Fair
Walk to School
March Fundraiser
SAW
Other:
Budget Account:
*
Please Select
Assemblies
Back to School
Book Fair
Classroom Supplies
Family Fun Night
Field Day
Field Trip
Fifth Grade Promotion
Garden Maintenance
Honorary Service Awards
Hospitality - Back to School Night
Hospitality - Honorary Service Awards
Hospitality - Meetings
Hospitality - SAW
Hospitality - Staff Lunch
Hospitality - Volunteers
Ice Cream Social
Kindness Week
Lunch Time Activities
Movie Night
Multicultural Night
Project Cornerstone
Pumpkin Patch
Red Ribbon Week
Reflections
Ruby Bridges Walk
Running Club
Spiritwear
St. Patrick's Day
STEAM Fair
Walk to School
March Fundraiser
SAW
Other:
Other event (please describe):
Other event2 (please describe):
Expense Line-1 description
*
Reason for Payment 1
Reason for Payment 2
Reason for Payment 3
Reason for Payment 4
Expense Line-1 amount: $
*
Expense Line-2 description
Expense Line-2 amount: $
Expense Line-3 description
Expense Line-3 amount: $
Expense Line-4 description
Expense Line-4 amount: $
TOTAL EXPENSE (read-only): $
Upload receipts for all expenses claimed in this form
*
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of
Total Amount Claimed From Above: $
*
Minus Advance Received: $
*
Reimbursement Claimed: $
*
Payment Amount:
Approved Amount:
Not claimed - donate to PTA: $
Refund to PTA (Enclose Check): $
Payment Method
*
Please Select
Check
Zelle
Please select how you would like to be reimbursed. Zelle is faster, takes 2-3 days after approval.
Zelle ID
Enter email or phone number registered with Zelle. Note that Treasurer will call you for verbal verification of transfer over Zelle.
$
Signature of Payee
*
Requested by
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Date for Zelle
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hidden Treasurer Field: Amount Advanced
Hidden Treasurer Field: check marks for "membership approved activity", "Funds released by membership", "Executive Board approved expenditure"
Zelle: Hidden Treasurer Field: check marks for "membership approved activity", "Funds released by membership", "Executive Board approved expenditure"
Hidden Treasurer Field: Expenses
Hidden Treasurer Field: Amount owed or Due
Hidden Treasurer Field: Expenses for Zelle
Signature of VP Events
President's Signature
President's Signature for Zelle
Date of President's signature
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Date of President's signature for Zelle
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
President: Enter date of next GA Meeting
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Signature of Treasurer
Date of Treasurer's Signature
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Secretary's Signature
Secretary's Signature for Zelle
Date Approved in Minutes
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Date Approved in Minutes for Zelle
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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