PTSA Request For Check Form

JANE ADDAMS PTSA
Check Request/Reimbursement Form

Check Request - Reimbursement Form 2016-17.jpg

Name (of requesting party): _______________________________________________

Check payable to (if different): _____________________________________________

Address: ________________________________________________________________

________________________________________________________________________


 

Phone #: _______________________________________________________________

Room #: __________ E
mail:____________________________________________


Date 
Description
Amount

______________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

TOTAL________________

1. Please complete this form and attach all relevant receipts
2. Submit to Treasurer or put in the Treasurer's PTSA Box
3. Note what you want done with your check:
____Put in my Box
____Mail it to me
____Other ____________________________________________________________

 


For Treasurer's Use:

Date_______________ Amount__________________
Check #____________ Category_________________

 

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