Check Request/Reimbursement Request Form

Instructions:

Please fill out completely with description of reimbursement and breakdown of expenses.
Attach a file/picture/scan of each receipt or supporting documentation.
A receipt of your submitted request will be e-mailed to you (please keep for your records).
The treasurers will e-mail you when your check is ready to be picked up at the school or has been mailed to you.
Questions? Please e-mail our treasurer at ______________________.

Name:

Phone Number

Email Address:

Grand total amount for reimbursement:

Would you like to pick up the check or have it mailed to your home (the address on your contact record)?*

Vendor

Expense category*

Amount