Colfax Spanish Academy PTO

Reimbursement Request

Requests turned in more than 45 calendar days after the event may be denied.

Your Name: Phone:

Date Submitted:

Check Payable to:

Full Address:

Project: Amount:

Reason for reimbursement:

Receipts totaling the amount of reimbursement must be attached.

Approved by (Event/Committee Chair):____________________________ Date __________

Approved by (PTO Officer):____________________________________ Date ___________

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For Treasurer's use only

Account_________ Check # ________ Dated ___________ Logged ______ Cleared _______