Walnut Creek Intermediate PTA

Request for Payment or Reimbursement

To Request Payment:

  1. Complete this form.  The budget category MUST be completed.
  2. If requesting reimbursement, attach all receipts.  
  3. If requesting direct payment, please attach supporting documentation including a copy of the contract or invoice to be paid.
  4. Place this form, with all attachments, in the Treasurer’s mail box in the office or mail to:

Heidy Leiva-Avalos

Walnut Creek Intermediate PTA

2425 Walnut Blvd, Walnut Creek, CA 94597

Mobile:  650-533-9202

Submitted by:                                                                                                         

Date:                                                   Phone:                                                         

Check Payable to:                                                                                                  

Select delivery method:

                 Please mail check to:                                                                                

                                                                                                                

                                                                                                                

                 Please place check in:                                                                        

Budget Category

Event / Activity

Description

Amount

$

$

$

TOTAL:

$

Treasurer:                                                                Date paid:                                

President:                                                                Check #:                                  

Secretary: