Reimbursement — Ridgeview Charter Middle School PTA

Payment Authorization / Request for Reimbursement

SUBMIT ALL RECEIPTS WITH THIS FORM

Date of Request

YYYY

Requestor Name

First Name

Last Name

Phone

(###)

###

####

Amount of Expense

Purpose of Payment Request

Name of Payee

(Same as above if for reimbursement)

Mail Check To

(Teacher reimbursements will be placed in school mailbox)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Electronic Signature Acknowledgement

By electronically typing your name in the signature field below, you agree that the typed name constitutes a valid electronic signature for purposes of this payment request. You also agree to abide by and follow the additional requirements listed below.

ADDITIONAL REQUIREMENTS:

Prior approval must be obtained on all purchases. Failure to obtain approval may result in purchaser having to incur the expenses.
Only expenses incurred in the current school year can be processed.
Receipts must be emailed directly to treasurer@ptarcms.org
Signature of the PTA President is required before Treasurer will issue check.