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Roxboro Elementary PTA - Reimbursement Request Form
** PLEASE NOTE: Receipts must be submitted within 30 days to be eligible for reimbursement.
Submitted by *
E-mail address *
Approver
Payment Information
Please complete this section if the PTA does not have your payee name and address on file. Payment will be mailed to the payee and address listed below.
Payee name
Address
City
State
Zip
Phone
Expense Information
Expense date *
MM
/
DD
/
YYYY
Event/Expense description *
Expense amount *
Receipts/Documentation
There are two ways to submit receipts or other documentation of your expense. If you have a google account, you can upload them to this form. If you don't (or just don't want to upload), you can email them to roxelpta+treasurer@gmail.com.
Upload Receipts Here (You must be signed in to a google account)
To complete this request, I will upload receipts to the question above, or e-mail photos/ scans of my receipts to the Roxboro treasurer at roxelpta+treasurer@gmail.com *
Required
I have completed the payee section above, or the PTA already has my name and address on file *
This is needed to have a reimbursement check mailed to you
Required
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