PTO Reimbursement Form

Instructions:

Fill out completely with description of reimbursement and breakdown of expenses by budget category.
Attach one file with copies of all receipts, preferably a PDF.
Specify how you would like to be reimbursed, usually, a check will be mailed to your address. During the pandemic, we suggest a Zelle transfer. If you prefer this method, please provide your email or mobile number we should send the payment to.
A receipt of your submitted request will be emailed to you (keep for your records)

Reimbursement Information

Check Payable To:

Total Amount For Reimbursement:

Provide the address to send the check to

Expense 1 - Amount

Account to Be Charged

Expense Is For:

Place of Purchase

Expense 2 - Amount

Account to Be Charged

Expense Is For:

Place of Purchase

Expense 3 - Amount

Account to Be Charged

Expense Is For:

Place of Purchase

Attach Receipts

Please attach one file with copies of all receipts

Attach Receipts - 2

Please attach additional receipts, if needed

Attach Receipts - 3

Please attach additional receipts, if needed

Approved By:

Approved by Date:

(to be completed by the Treasurer)

Date Check Issued

Check Number:

Notes

Thank you for partnering with us. We appreciate your support.

If you have any questions about this reimbursement, please contact the treasurers at treasurer@unidospto.org.