Samuel Beck Elementary PTO

Reimbursement / Payment Voucher

 

This form must be used for all reimbursement and payment requests.

 Fill out and submit this form, along with all receipts / bills within 60 days of expenditure. 

The treasurer will pay by check according to the information given and within budget guidelines.

 Payment requested by______________________________________

Address_________________________________________________

Phone ________________________Date_____________________

Make check payable to:_____________________________________

 Item(s) Purchased                         Budget Catagory *Required*                Amount

_____________________                ______________________         ___________

 _____________________                ______________________         __________

 _____________________                ______________________          __________

 _____________________                ______________________          __________

 _____________________                ______________________          __________

                                                                                               TOTAL $