Wayland Public Schools PTO

Payment Request Form

Please complete and submit this form along with receipts:


Form Completed by: _________________________________   Date: _____________        

How to contact you with questions:   _______________________________________

Payment Information

Amount of Payment:         _______________          Payment Due Date:  _______________

Invoice attached?              Yes        No

Receipts attached?             Yes            No

Payee Name and Address:

Payment Description:

Accounting Information

School:                Happy Hollow                                   Grade:   _______________

Account (circle):

6118        Grade Level Enrichment                6190         Curriculum Materials

6210         Teachers Supplies                        6800         Wish List/Capital



Treasurer’s Approval: ____________________________        Date:  _________________