Teller PTA Funds Request/Reimbursement/In-Kind Donation Form
To request a payment or in-kind donation receipt from the Teller PTA, please complete this form. Use one form for each check or in-kind donation receipt requested.

Please place the receipts in a sealed envelope addressed to “PTA TREASURER,” and place it in the PTA mailbox (front office), email an electronic copy of all documents to: treasurer@tellerpta.org, or Mail to: 1150 Garfield St, Denver, CO 80206 (Attn: Teller PTA Treasurer).

Receipts must be submitted for expense reimbursement. If there are more than 4 receipts, please request a paper form from treasurer@tellerpta.org. Checks will not be issued without a request form.

Note that payments may be delayed if the budget category requires a membership vote.

Your check or in-kind donation receipt will be mailed to the address listed within two weeks of the receipt by the Treasurer.

Type of Request: *
Name of person making request *
Your answer
Email Address of the person making request. *
In case we have any questions
Your answer
Phone # of the person making request. *
In case we have any questions
Your answer
Check Request/Expense Reimbursement/In-Kind Donation Information *
Provide a short description of the category of vendor check, expense reimbursement, or in-kind donation request.
Your answer
Make Check, Reimbursement, OR In-Kind Donation Receipt payable/addressed to: *
Name of person or vendor who will receive the check or in-kind donation receipt.
Your answer
Address *
Please enter complete mailing address (Street, City, State, ZIP) for the person / vendor who will receive the check or where in-kind donation receipt should be sent.
Your answer
Total Amount Requested: *
Enter TOTAL AMOUNT Requested ($ to vendor, Total sum of receipts for expense reimbursements, or estimated $ value of in-kind donations). For expense reimbursements, enter individual receipt values below. Receipts are required for expense reimbursements.
Your answer
Special Requests/Notes:
Your answer
In-Kind Donation Option:
Check this box if you would like your expenses to be considered an in-kind donation to Teller Elementary PTA. Please send me a letter acknowledging my donation for tax purposes.
Receipt 1
Date 1
MM
/
DD
/
YYYY
Description 1
Your answer
PTA Activity 1
Your answer
Store / Vendor 1
Your answer
Amount 1
Your answer
Receipt 2
Date 2
MM
/
DD
/
YYYY
Description 2
Your answer
PTA Activity 2
Your answer
Store / Vendor 2
Your answer
Amount 2
Your answer
Receipt 3
Date 3
MM
/
DD
/
YYYY
Description 3
Your answer
PTA Activity 3
Your answer
Store / Vendor 3
Your answer
Amount 3
Your answer
Receipt 4
Date 4
MM
/
DD
/
YYYY
Description 4
Your answer
PTA Activity 4
Your answer
Store / Vendor 4
Your answer
Amount 4
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Teller Elementary PTA. Report Abuse - Terms of Service