Request for Reimbursement Form - Free Download
4.6, 3754 votes
Please vote for this template if it helps you.
Request for Reimbursement Form
Request for Reimbursement Form
PAYMENT AUTHORIZATION/REQUEST FOR REIMBURSEMENT
ATTACH ALL RECEIPTS TO THIS EXPENSE STATEMENT
Name ________________________________________________________________________________________
PTA Position __________________________________________________________________________________
Address ______________________________________________________________________________________
City/Zip ______________________________________________________________________________________
Telephone (______)_______________________ Email ________________________________________________
Expenditure was for: __________________________________________
List Expenditures: ______________________ $ __________
______________________ $ __________
______________________ $ __________
______________________ $ __________
TOTAL EXPENSE $ __________
Total Amount Claimed From Above $ __________
Minus Advance Received $ __________
Reimbursement Claimed $ __________
Not claimed – donate to PTA $ __________
Refund to PTA (Enclose Check) $ __________
Signature __________________________________________________________ Date _____________________
FOR PTA TREASURER USE:
r
Membership-approved activity r Funds released by membership
r Executive Board-approved expenditure
President’s signature: _______________________________________________________ Date: ________________________
Date approved in minutes:______________________ Secretary’s signature: __________________________________________
03/2009
Check Number Category Amount Advanced Expenses Amount Owed or Due
328 California State PTA Toolkit – 2013
Request for Reimbursement Form Previous Page
Request for Reimbursement Form
Previous

1/1

Next