REQUEST FOR REIMBURSEMENT

REQUEST FOR REIMBURSEMENT

Academy of Alameda PTSA
Reimbursement Guidelines:
- Use this form to request reimbursement for expenses paid on behalf of AOA PTSA.
- Submit a separate request for each business purpose and expenditure date. Multiple receipts may be included if they relate to the same purpose and date.
- This form can be used for both reimbursements and direct vendor payments. For vendor payments, enter the vendor’s name and address in the Payee fields and your own name as the Requestor.
- Verify the payee name and mailing address before submitting. Submission does not guarantee approval.
- Once approved and processed, a check payable to the Payee listed below will be mailed to the address provided.
- Please contact the Treasurer with any questions.
Name of Payee (Name on Check)

First NameLast Name
Requester Name (if different from Payee)

First NameLast Name
PTA Position
Mailing Address for Check

Street Address

Street Address Line 2

City, State, ZipState / Province

Postal / Zip Code
Telephone
Format: (000) 000-0000.
Email
example@example.com
Business Reason
Date of Expenditure (One date per request)

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Total Reimbursement Requested (in $)
Upload Receipts

Attach all receipts for this payment
Cancelof
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Comments

REIMBURSEMENT SUMMARY

Treasurer Preparation