PTA Reimbursement Request Form

This form should be used when something has been purchased on behalf of the WSE PTA and the purchaser is requesting reimbursement. Please complete a separate form for each purchase and include a receipt.

Reminder: the PTA cannot reimburse sales tax.

Date Submitted:

Individual Requesting Reimbursement:

Email:

Reimbursement Check Payable To:

Check will be placed in staff or PTA on-campus mailboxes unless alternate needed. Please note here if you need the check mailed or delivered in a different manner.

Brief description of items purchased:

Vendor:

Amount:

Expense Category:*