Reimbursement & Payment Request Form

This form should be used to:

Request payments made directly to vendors or suppliers for PTA-approved programs or events.
Request reimbursement for personal funds spent on PTA-approved programs or events.

Please note: In accordance with PTA guidelines, gift cards are not allowable expenses and will not be reimbursed.

Instructions:

Complete all required fields. Be sure to include a clear description of the reimbursement and a breakdown of expenses.
Attach all required receipts and/or invoices. These are mandatory for all reimbursement or payment requests.
A confirmation email will be sent once your request is submitted. Please save this for your records.
The PTA Treasurer will notify you when your payment is ready for pick-up or has been mailed.
Gift cards may not be purchased with PTA funds. These expenses will not be approved.
Whenever possible, please keep reimbursable expenses on a separate receipt/transaction from personal purchases. If combined, highlight all reimbursable items and clearly indicate the total amount requested on the receipt.
The form accommodates up to 10 line items. If more than 10 items is required, please group expenses together or fill out an additional form.


Payee Information
Write check payable to (Name of Person/Company) (Required): Payment request type (Required): (reset) Pick up check from Front Office Mail check to below address Mailing Address (only required if check is to be mailed)

Requestor Information
Name of Person Requesting Check (Required): PTA Position If not a part of PTA, describe your involvement. Email or Phone (Required): Provide the email address or phone number where you'd like to be notified when your check is ready for pick-up.

Reimbursement Information
Program or Event Name (Required): Total Amount of Reimbursement Requested (Required):

List Expenditures
Item #1 (Required): Item#1 Amount (Required): Item #2: Item#2 Amount: Item #3: Item#3 Amount: Item #4: Item#4 Amount: Item #5: Item#5 Amount: Item #6: Item#6 Amount: Item #7: Item#7 Amount: Item #8: Item#8 Amount: Item #9: Item#9 Amount: Item#10 Amount: Item #10:

Reimbursement Information
Attach Receipt (Required): Receipts are required for reimbursement. If you have multiple receipts, attach them below. Additional Receipts: Additional Receipts: Additional Receipts: Additional Receipts: Additional Receipts: Additional Comments/Instructions:

Sign
Requestor Signature (Required): Type your full name to digitally sign this form.

Payment Schedule

Requests are reviewed and issued weekly.
If you have a time-sensitive request, please reach out to the treasurer in advance.

Questions?

Contact: treasurer@beaconparkpta.org