Don Benito PTA Reimbursement / Check Request Form

Use this form to submit check requests for expenses incurred or payments to be made. ALL payments or reimbursements are subject to approval of Don Benito PTA President, Treasurer and/or appropriate Committee Chairperson, and are limited to budgeted funds approved by PTA membership. If you need help at any time, please email treasurer@donbenitopta.com

Full Name*

E-mail*

Check Made Payable To:*

Address to send check

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

This form allows you to enter up to 4 expense categories on a single form. If you have more than 4 expense categories, please file a separate form for the additional ones.

Expense #1 Description*

Enter a description of the item expense

Budget Line Item for Expense #1*

Total Expense #1*

Expense #2 Description

Enter a description of the item expense

Budget Line Item for Expense #2

Total Expense #2

Expense #3 Description

Enter a description of the item expense

Budget Line Item for Expense #3

Total Expense #3

Expense #4 Description

Enter a description of the item expense

Budget Line Item for Expense #4

Total Expense #4

Total from all Receipts

Receipt / Invoice Image Upload*

Upload a File

Additional Comments

Enter the message as it's shown*

Type a question

For PTA Treasurer

Budgeted FundsChairperson Approved (if applicable)