GHES-PTA Reimbursement Form

GHES-PTA Reimbursement Form
Request for Reimbursement

Please submit this form to request reimbursement, but in order to receive your check we must also have a copy of the corresponding receipts. Please email a copy of your reciepts to ghptatreasurer@gmail.com. Thank you.
Date

Month Day Year
Requested By *

First Name Last Name
Phone Number *

Area Code Phone Number
E-mail *
Account to be Charged: *
Make Check PAYABLE to: *
Amount of Request: *
Description of Expense: *
Signature of Person Requesting Funds:

Clear
Send Check Home (with Child or via Mail): *
Child:

First Name Last Name
Teacher:

First Name Last Name
If by Mail, Send To Address:

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Should be Empty:

Request for Reimbursement